In fact, it has been noted that equity or fairness in health financing, where households contribute to the health system according to their ability to pay atp, should form an important health system goal to promote universal health. See general information about how to correct material in repec for technical questions regarding this item, or to correct its authors, title, abstract. Progressivity indices for four sources of health care financing. Using this and other progressivity measures, the paper i documents a decline in progressivity over the last decades and ii examines the relationship between progressivity and economic growth. Apart from the progressive tax structure, the basic tax credit and tax credits for transfer incomes appear to be the main factors. As can be seen, the prereform income tax was progressive kakwani index is 0.
Empirical results are presented and commented in section 2 for the 19652000 period. If you dont see any interesting for you, use our search form on bottom v. A negative index shows a regressive financing mechanism and a positive index a progressive mechanism. Kakwani 1993 rigorously formulated properties for an index of this type and suggested a particular index. This study aims to assess inequity in expenditure on sexual and reproductive health srh services in india and kenya.
Measuring progressivity of health care payments introduction. Consequently there are several aspects that ought to be taken into. Vertical and horizontal equity of funding for malaria control. Title measuring improvement in wellbeing sub title author.
Decomposition of change in sgini coefficient of inequality. A set of popular tools of studying progressivity, such as the concentration curves and kakwani progressivity index, are used. Agricultural modernization, structural change and propoor. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Title index establishment size, public administration and government wage differentials 545 belman, d. Pdf inference tests for ginibased tax progressivity indexes. Table 1, column a shows the cumulative share of income recipients. This is the difference between the concentration index of taxes and the gini index of gross incomes. Decomposition of inequality change into propoor growth. Kakwani index is equal twice the area between the lorenz curve and the concentration curve of a tax, or transfer. Inference tests for ginibased tax progressivity indexes. All material on this site has been provided by the respective publishers and authors.
Measurement of income inequality forman christian college. It is the difference between a concentration index. Reynolds and smolenskys 1977 index of the redistributive effect. The effects are more pronounced when the negative deduction is taken into account total net income instead of net of tax income with a reynolds. The distribution, amount, and equity of government subsidies delivered via ncms to rural. It was shown that income inequality of employees income has somewhat increased in this period, using the gini coefficient as the indicator of income inequality. World happiness report 2012 ubc library open collections.
Statistical software components from boston college department of economics. We analyzed spending on maternity care in urban slum communities in mumbai to better understand the equity of spending and the impact of spending on household poverty. Through grouped data of household budget published by iran statistic center isc and beta lorenz curve introduced in kakwani 1980, it has been tried to extract beta lorenz curve and kakwani progressivity index in each individual rural and urban district, and also to obtain other inequality. Who benefited from the new rural cooperative medical. It is a revised and upgraded version of inequal published by edward whitehouse in stb23. The inference procedures are illustrated by applying them to luxembourg income study microdata for sweden, the united kingdom, and the united states before and after periods of tax reform. Country health profile 2017 portugal contents 1 highlights 1 2 health in portugal 2 3 risk factors 4 4 the health system 6 5 performance of the health system 8 5. If the kakwani index is normalized, an ordered weighted. Our modification is to measure inequality using the ratio of the concentration index to the gini coefficient instead of the difference between them. When requesting a correction, please mention this items handle.
A constructive proposal,world development, 258, 12831298. Out of pocket payment oop, a source with high share to total health expenditure, is an inequitable mechanism for health financing. On the other hand, it may prevent the sick from accessing needed care. The kakwani index of progressivity equals twice the area between the lorenz curve and the concentration curve of a tax. The aim of this study was to investigate the dental expenditure, ana. Quantitative approaches to multidimensional poverty. Exercise files zip file inequality and hdi exercise files. Vertical inequity was then measured through the kakwani index ki, which is the most widely used measure of progressivity in financing of a health system.
We also propose a measure using the gini coefficient or concentration index of consumption. This paper discusses how the structure of the tax system affects its progressivity. In this paper we introduce a new methodology to study the degree of progression as well as the redistributive and reranking effects of a personal income tax system by employing and extending the new inequality curve and index proposed by michele zenga. Incomerelated inequality in health care financing and. The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. The reynoldssmolensky index of progressivity equals twice the area. Kakwani and pernia 2000, mcculloch, robson, and boulch 2000, ravallion and chen 2003, and son 2003. In this study we consider two widely used gini based indices. Section 3 uses the decomposition of the kakwani index to identify the main components of tax progressivity. Equity in financing and use of health care in ghana, south.
The kakwani index computes the departure from proportionality of a progressive income tax by measuring the difference between the. In addition, we propose an analytical method to decompose the total progressivity measured by the contributions of different taxes or benefits. Kakwani indices for financing sources in ghana, south africa, and tanzania. A very popular index of progressivity is the one proposed by kakwani 1977a which. This article is from international journal for equity in health, volume 10. A note on the maximum value of the kakwani index ideasrepec. An alternative way to obtain the concentration index is outlined in kakwani et al. This paper analyzes inequality in irans health system from a financing perspective. Following the methodology proposed by wagstaff et al. Nov 27, 2015 on this page you can read or download chudai kahani pdf file in pdf format.
The kakwani index computes the departure from proportionality of a progressive income tax by measuring the difference between the concentration coefficient for tax liabilities and the gini coefficient for pretax incomes. The goal of the new rural cooperative medical system ncms is to decrease the financial burden and improve the health of rural areas. The vertical equity index v is equal to kakwani progressivity index kpt scaled by the average tax rate tx, and normalized by. Fairness in a countrys health financing system is a key dimension to assess a health systems performance world health organization, 2000.
Sen 1981, 1985, dasgupta and weale 1992, dasgupta 1993 and kakwani 1993. Nanak kakwani and hyun hwa son make use of social welfare functions to derive indicators of development relevant to specific social objectives, such as poverty and inequalityreduction. A note on the maximum value of the kakwani index request pdf. Tackling income inequality the role of taxes and transfers isabelle joumard, mauro pisu, debbie bloch online first. Title relative deprivation and satisfaction orderings sub. Estimates of a traditional aggregate import demand model for five countries f14 asseery, a. Decomposition of inequality change into propoor growth and mobility components. We propose simple modifications for the kakwani tax progressivity measure that make it suitable for evaluating access inequality for medical services.
Sep 15, 2016 there are positive and negative consequences of the implementation of out of pocket oop payments as a source of the healthcare financing. New evidence on financing equity in chinas health care. Using this and other progressivity measures, the paper i documents a decline in progressivity over the last decades and ii examines the relationship between. The inequity of the swiss health care system financing from a. Re is very similar to re in 1, but instead of gini coefficient of postfiscal income n. The paper concentrates on the poverty measure proposed by kakwani. A paradoxical situation in regressivity or progressivity. The kakwani index uses the gini framework to measure how progressive a social intervention is. Health policy and equity of health care financing in australia. Arguing that the measurement of development cannot be valuefree, the authors assert that if indicators of development are to have policy relevance, they must. The findings indicate that laborusing technological change generates absolute and relative propoor effects whereas. Equity in health financing as one main aspect of health equity plays an essential role on the path toward universal health coverage.
On the one hand, oop burden increases awareness of treatment costs and limits unnecessary use of healthcare services. The kakwani 1977 index of tax pro variance is between taxes and the cugressivity is defined as twice the area be mulative share of income recipients or of tween the concentration curves for taxes pretax income. Kakwani decomposition of redistributive effect core. A modified kakwani measure for health inequality health. This paper analyses the distribution of employee income in slovenia in the period 19912009. Heywood estimated elasticities from regulated and unregulated cost functions d21 nelson, randy a. Son abstract this paper proposes a new propoor policy ppp index, which measures the propoorness of government programmes, as well as basic service delivery in education, health and infrastructure. A measure of the progressivity or regressivity of health care payment systems. In empirical analysis, the kakwani index is the most frequently used indicator for comparing progressivity across countries and over time. It is equal to the difference between the gini index for the social. Stata module for decomposition of progressivity measurements. How to do or not to do a health financing incidence analysis. According to kakwani and pernia 2000, this entails the removal of all institutional and policyinduced biases against the poor, as well as the adoption of direct propoor policies kakwani and.
Kakwani 1980 proved that if a persons depression is proportional to the square of income differences, the resulting index of average deprivation becomes the coefficient of variation. In case of maximum progression, that is a situation in which only one taxpayer faces the overall tax burden, the index reaches its theoretical maximum value, given by 1. Jun 27, 2011 the kakwani index for measuring progressivity of health care financing. Maternal and neonatal health expenditure in mumbai slums. The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. Universitv of sussex, brighton bni 9qn, uk department of health policv and management. Kwakwani is a mining and logging town on the berbice river in the upper demeraraberbice region of guyana, some of the world best woods for building and construction can be found here. Reading list suggested basic readings on this topic. The kakwani index is a measure of the progressivity of a social intervention, and is used by. Research open access changes in equity in outofpocket. The distribution of wages and employee incomes in slovenia.
This is a unique book on the most important quantitative approaches to multidimensional poverty measurement, gathering in one place the various techniques of measurement, as well as offering both a simple introduction to the nonspecialist reader of each quantitative approach and an illustration based on empirical applications to various countries. Vi incomerelated inequality in health care financing and utilization in estonia since 2000 acknowledgements the policy paper has benefited greatly from the comments by sarah thomson, tamas evetovits, matthew jowett, enis baris, triin habicht and seminar participants in barcelona, geneva and tallinn. The overall tax revenue of a realworld personal income tax cannot be eventually paid only by the richest taxpayer. Data for this study were collected as a part of the situational analysis for the diagonal. Kakwani 1984 defined the plot of the sum of income share shortfalls of different individuals from richer individuals against the. Please note also that erreygers 2009 a, b has commented on the useappropriateness of the normalisation suggested by wagstaff 2005. A note on the maximum value of the kakwani index springerlink. This paper applies the framework for propoor analysis to welfare changes from a cgemicrosimulation model to analyze what are the better or worse models for agriculture modernization, and to estimate the contribution of growth and redistribution to changes in poverty in drc. Related but distinct tests for the reynoldssmolensky index of residual progression and the kakwani index of liability progression are provided. In the case of taxprogressivity and incomeredistribution indices, there have been few references so far. It is named after the economist who first proposed and used it, nanak chand kakwani.
The oop has been considered regressive kakwani index with a negative value in nature. Inequity in costs of seeking sexual and reproductive. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending. The purpose of the present study is to determine how government subsidies vary between poorer and wealthier groups, especially in lowincome regions in rural china. In addition to estimating contributions to each financing mechanism as a percentage of consumption expenditure in each quintile, it was necessary to calculate the incidence of financing using the lorenz and concentration curves to establish whether a health care financing mechanism is progressive, regressive or. Gini indices posses all the properties but they are not decomposable additively or nonadditively. The global indirect system can be considered to be progressive overall, according to the kakwani index. Most systems in the region have opted for some form of universal coverage, or aspire to achieve it. Such an index is often used for comparison of wellbeing across countries, e.
The results of studies based on the kakwani and concentration indices are show in the charts figure 2, figure 3 download. Pdf distributionfree statistical inference procedures for changes in lorenz and ginibased indexes of tax progressivity are developed and applied find, read and cite all the research you. Decomposition of progressivity and inequality indices. Given an income distribution, the zenga curve compares the economic conditions of two exhaustive groups of population obtained by dividing. According to loizides 1988 3 greece has also opted for a high degree of progressivity kakwani index of 0. Nov 28, 2015 on this page you can read or download download assamese novel in pdf file in pdf format. The analysis is based on two different datasets, both derived from the personal income tax files. This is the difference between the concentration index of taxes and an inequality index such as the gini index of gross incomes. More attention should be paid on the protection of low. Comparing redistributive efficiency of taxbenefit systems in. This paper uses the ninth round of the rlms survey to assess the distributional consequences of the two major components of the indirect tax system.
Financial protection against the cost of unforeseen ill health. The kakwani is often assumed to measure to what extent a policy design is targeted to the poor. International comparisons nanak kakwani and hyun h. In total 77 publications which fulfilled the criteria, based on screening of the title, were identified in the databases. The kakwani index is a measure of the progressivity of a social intervention, and is used by social scientists, statisticians, and economists. The swiss health care system is based on a mixed privatesocial health insurance, and it is financed through several sources in brackets the 2009 shares on the total health care costs. At the same time, we observe that expenditures on informal payments became less regressive during the reform period kakwani index increases from.
The concentration index, the gini coefficient, and the kakwani index. Measuring the redistributive impact of taxes and transfers abstract this paper provides a theoretical foundation for analyzing the redistributive effect of taxes and transfers for the case in which the ranking of individuals by prefiscal income remains unchanged. Therefore, the maximum concentration coefficient for taxes cannot be equal to 1, and, consequently, the maximum value of the kakwani index cannot be 1 minus the gini coefficient for pretax incomes, as generally described in the related literature. It suggests a measure of progressive capacity of tax systems, based on the kakwani index, but independent of pretax income distributions. We used expenditure data for maternal and neonatal care, collected during postpartum interviews. We demonstrate the computation of these indices using data from irs statistics of income bulletin for the year 2006. The redistributive effect and progressivity of taxes revisited aias. This is also the difference between the concentration index of the tax ic x and the gini index of gross income. We study the progressivity of australias personal income tax system after the introduction of a new tax system goods and services tax act 1999.