10 Several analytical tools are available for assessing pro-poorness of public health financing to inform policymakers
about the fairness of existing mechanisms. Arguably the two most influential methods for assessing equity in health financing in recent years are selleckchem U0126 benefit incidence analysis (BIA) and financing incidence analysis (FIA), sometimes referred to as progressivity analysis.16 17 BIA estimates the distributional impact of public spending on healthcare. It measures the extent to which different socioeconomic groups benefit from a public subsidy for health through their use of health services.17 Conducting BIA involves several key steps including ranking the study population by a living standard measure, assessing the rate of utilisation of different types of health services, estimating the unit cost of each type of service and multiplying the utilisation rates by the unit costs to determine the amount of subsidy. These steps are outlined in table 1. Table 1 Key steps in conducting BIA BIA results are typically presented either as a percentage share of total benefits accruing to each socioeconomic group or by using concentration curves and concentration indexes (CI). Results presented as a percentage share of benefits
are visually appealing and easy to understand but they do not offer a conclusive answer as to whether a distribution is pro-poor or pro-rich.18 However, the CI, which is directly related to the concentration curve, quantifies the degree of inequality
in the distribution and is the most appropriate when comparing results across many time periods, countries or regions.19 Traditionally, the applicability of BIA has been largely confined to the distribution of public subsidy,17 but in recent years this has been extended to the private sector.7 FIA assesses the distribution of the burden of health financing and sometimes the extent to which this burden affects the underlying distribution of income.20 To maintain an equitable health financing system, it is Cilengitide generally believed that payment for healthcare should be on the basis of ATP. FIA therefore measures the progressivity of health financing systems by assessing the departure from proportionality in the relationship between payments for healthcare and ATP.21 Table 2 highlights the key steps in conducting FIA. A financing system is progressive when households with higher income contribute a higher share of their income towards health than those with lower income; it is regressive when households with lower income contribute a higher share of their income towards health than those with higher income; and proportional when everyone contributes the same percentage of income regardless of their income level.