Abstract
Macro-economic indices for measuring equity in health finance and delivery 1986-1998 Explicit policy on health equity will create demand to measure and monitor the achievements of health equity in the country. At least three disciplines express concerns on health equity: public health, economics and social science. This study employed the macro-economic indices to measure equity in health finance and health delivery. The interpretation of equity in health finance was based on the principle of ability to pay. Kakwani index of progressivity was used to reflect the ability to pay of each source of health finance. Equity in health delivery was interpreted that health care be allocated according to health need. Those who were sicker should seek more care than the healthier. The concentration index was used to measure equity of health delivery. The National Statistical Office’s socioeconomic and health and welfare surveys during 1986 to 1998 were used to demonstrate the equity trends in Thailand. Since the health and welfare surveys contained no data on household income, the indirect method was used to map the income of the household in the socioeconomic surveys to household in the health and welfare surveys by education and occupation of household heads. Kakwani indices proved that health finance system was regressive to income, the trend established less regressivity from 1986 to 1996. The causes of inequity were explained by an increase trend of income disparity (by the Gini coefficient) and the regressivity of Kakwani indices for both public and private sources of finance. Concentration indices for health problems were also regressive to income, i.e. the poor were more ill than the rich. When compare illness with delivery (seek care from drug store, health centre, clinic, public and private hospitals), the concentration indices showed progressivity patterns, i.e. the rich were more likely to use health care, controlling for same health need. Further standardisation removing the effects of age and sex, the inequity patterns slightly reduced. This research suggested that the health equity policy goal in Thailand should be more explicit. Especially, the goal of equity in health finance should be set by reducing income distribution disparity, the progressivity of the whole tax system and contribution from the social security scheme, with less emphasis on the user fee at the point of delivery. Information system should be improved to help monitor equity in health delivery.
