Journal Article

How equitable is health spending on curative services and institutional delivery in Malawi? Evidence from a quasi-longitudinal benefit incidence analysis

Rudasingwa, Martin, Ridde, Valéry, Muula, Adamson Sinjani, De Allegri, Manuela, Bonnet, Emmanuel, Yeboah, Edmund

2022

Overview

Background Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. Understanding the distributional impact of health spending over time due to these policies has received limited attention. Our study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016. Methods We relied on a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. We used data from household surveys and National Health Accounts. We used a concentration index (CI) to determine the health benefits accrued by each socioeconomic group. Results Socioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. Between 2004 and 2016, the inequality in public spending on curative services decreased from a CI of 0.037 (SE 0.013) to a CI of 0.004 (SE 0.011). Whiles, it decreased from a CI of 0.084 (SE 0.014) to a CI of 0.068 (SE 0.015) for overall spending in the same period. For institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a CI of 0.032 (SE 0.028) to a CI of -0.057 (SE 0.014) and from a CI of 0.036 (SE 0.022) to a CI of 0.028 (SE 0.018), respectively. Conclusions Through its free healthcare policy, Malawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. Our findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Access / Benefit incidence analysis / Economic aspects / Economic equity / Economic research / Egalitarianism / Equality and Human Rights / Funding / Government spending / Health care / Health care access / Health care expenditures / Health care facilities / Health care policy / health care utilization / Health disparities / Health facilities / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Research / health spending / Inequality / Initiatives / Life Sciences / Malawi / Medical care, Cost of / Medical economics / Medical policy / Medicine / Medicine & Public Health / Mortality / National health insurance / Obstetrics / Popularity / Public finance / Public Health / Public health clinics / Santé publique et épidémiologie / Social Justice / Social Policy / Socioeconomic factors / Socioeconomics / Subsidies