Showing papers by "Adam Wagstaff published in 2015"
TL;DR: In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities as discussed by the authors.
428 citations
TL;DR: In this article, the authors proposed a "mashup" index that captures both aspects of UHC: that everyone, regardless of their ability-to-pay, gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care.
Abstract: The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35–57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data—by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.
68 citations
TL;DR: The recent paper by Garcia-Gomez et al. as mentioned in this paper is part of a rapidly growing industry aiming to quantify, and hence give some policy teeth to, the concept of inequality of opportunity.
Abstract: The recent paper by Garcia-Gomez et al. (2014) in this journal is part of a rapidly growing industry aiming to quantify, and hence give some policy teeth to, the concept of inequality of opportunity. The idea behind the concept is simple yet powerful. Not all inequality is bad. The bad bit of inequality (‘inequality of opportunity’) is the part that emerges because of factors over which we have no control (our ‘circumstances’). By contrast inequality that emerges because of our different choices and efforts (holding constant our circumstances) is fine, and to be encouraged. On the face of it, questioning the usefulness of inequality of opportunity seems about as wrongheaded as questioning the merits of family vacations, Thanksgiving or dessert trolleys. What’s not to like about it? We argue below, as we have argued at greater length elsewhere (Kanbur and Wagstaff 2015), that the idea is not quite as useful as it might at first glance appear, and is in fact rather dangerous. But turned upside down, it might yet be useful.
52 citations
TL;DR: This work operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and constructed an overall index of universal health coverage achievement, using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries.
Abstract: Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens’ rights to health care and counting the number of people who are in a financial protecti...
49 citations
TL;DR: The authors emphasize that the value judgment between attainment and shortfall gets intertwined in practice with thevalue judgment of whether it is absolute or relative inequality that matters.
Abstract: Value judgments lurk beneath the surface in any study of health inequalities; analystsought to understand them, make them explicit, and present results transparently to policymakersso that they, rather than analysts, decide which set of value judgments should beinvoked. The authors emphasize that the value judgment between attainment and shortfall gets intertwined in practice with the value judgment of whether it is absolute or relative inequality that matters.The fact is that the two types of inequality are not just related to one another, but are related in such a way that we can say which type of inequality is harder to reduce: reducingabsolute inequality is a good deal harder than reducing relative inequality.
9 citations
Journal Article•
6 citations
TL;DR: The authors welcome the comments of Pedro Rosa Dias and Erik Schokkaert on the authors' Editorial as a means of stimulating further debate on the usefulness of estimates of inequality of opportunity, especially for policy purposes.
Abstract: The authors welcome the comments of Pedro Rosa Dias and Erik Schokkaert on our Editorial as a means of stimulating further debate on the usefulness of estimates of inequality of opportunity, especially for policy purposes. Our responses to their comments are in three categories. First, they broadly agree with many of our criticisms of the Paes de Barros et al. approach to measuring inequality of opportunity, but they say that these criticisms are already well appreciated in the literature. The authors beg to differ. Given our knowledge of work in policy settings, the authors believe that strong health warnings are in order. Second, the authors feel they do not sufficiently engage with a number of our points, including on talent and on luck. Third, while we agree with them that a strong focus on the income-health gradient leaves out many other considerations, the authors will nevertheless continue to argue for this focus on pragmatic grounds in the realm of policy.
4 citations
Posted Content•
TL;DR: In this article, the authors proposed a ''mashup'' index that captures both aspects of universal health coverage (UHC): that everyone regardless of their ability-to-pay?gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care.
Abstract: The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ?mashup? index that captures both aspects of UHC: that everyone?irrespective of their ability-to-pay?gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35?57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data?by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.
1 citations
Posted Content•
TL;DR: In this paper, the authors proposed a "mashup" index that captures both aspects of UHC: that everyone -- irrespective of their ability-to-pay -- gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care.
Abstract: The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a 'mashup' index that captures both aspects of UHC: that everyone -- irrespective of their ability-to-pay -- gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35-57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data -- by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.