世界経済・社会統計 = World development indicators

计量经济分析 = Econometric analysis

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61690-6.pdf

Closing the gap in a generation: health equity through action on the social determinants of health

https://link.springer.com/content/pdf/10.2307%2F3343168.pdf

Development as Freedom

The global burden of disease.

While there is a great deal of anecdotal evidence on the economic effects of adverse health shocks, there is relatively little hard empirical evidence. The author builds on recent empirical work to explore in the context of postreform Vietnam two related issues: (1) how far household income and medical care spending responds to health shocks, and (2) how far household consumption is protected against health shocks. The results suggest that adverse health shocks - captured by negative changes in body mass index (BMI) - are associated with reductions in earned income. This appears to be only partly - if at all - due to a reverse feedback from income changes to BMI changes. By contrast, there is a hint - the relevant coefficient is not significant - that adverse BMI shocks may result in increases in unearned income. This may reflect additional gifts, remittances, and so on, from family and friends following the health shock. Medical spending is found to increase following an adverse health shock, but not among those with health insurance. The impact for the uninsured is large, equal in absolute size to the income loss associated with a BMI shock. The lack of impact for the insured points to complete insurance against the medical care costs associated with health shocks, and is consistent with the very generous coverage of Vietnam's health insurance program in this period. The question arises: have Vietnamese households been able to hold their food and nonfood consumption constant in the face of these income reductions and extra medical care outlays? The results suggest not. For the sample as a whole, both food and nonfood consumption are found to be responsive to health shocks, indicating an inability to smooth nonmedical consumption in the face of health shocks. Further analysis reveals some interesting differences across different groups within the sample. Households with insurance come no closer to smoothing nonmedical consumption than uninsured households. Furthermore, and somewhat counterintuitively, better-off households - including insured households - fare worse than poorer households in smoothing their nonmedical consumption in the face of health shocks, despite the fact that in the case of insured households there are no medical bills associated with an adverse health event. Why the poor rely on dissaving and borrowing to such an extent, and do not apparently reduce their food and nonfood consumption following an adverse health shock while the better-off do, may be because the levels of food and nonfood consumption of the poor are simply too low relative to basic needs to enable them to cut back in the face of an adverse BMI shock.

/pdf/the-economic-consequences-of-health-shocks-4wcqjts8iu.pdf

The economic consequences of health shocks

Efficiency Measurement in the Public Sector: An Appraisal

Among the conclusions the authors reach about malnutrition rates, among different economic groups: 1) inequalities in malnutrition almost disfavor the poor; 2) it's not just that the poor have higher rates of malnutrition. The rate of malnutrition declines continuously with rising living standards; 3) the tendency of poorer children to have higher rates of stunting, and underweight, is not due to chance, or sampling variability. Inequalities in stunting, and underweight, as measured by the concentration index, are statistically significant in almost countries; 4) inequalities in underweight tend to be larger than inequalities in stunting, which tend to be larger than inequalities in wasting; 5) in most cases, whatever the malnutrition indicator, differences in inequality between countries are not statistically significant; 6) even if attention is restricted to the cross-country differences in inequality that are statistically significant, interesting conclusions emerge, Egypt, and Vietnam have the most equal distributions of malnutrition, and Nicaragua, Peru, and, to a lesser extent, Morocco, have highly unequal distributions; 7) some countries (such as Egypt and Romania) do well in terms of both the average (the prevalence of malnutrition) and the distribution (equality). Others do badly on both counts. Peru, for example, has a higher average level of stunting than Egypt, and higher poor-non-poor inequality. But many countries do well on one count, and badly on the other. Brazil, for example, has a far lower (less than 20 percent) stunting rate overall, than Bangladesh (more than 50 percent), but has four times as much inequality (as measured by the concentration index); 8) use of an achievement index that captures both the average level, and the inequality of malnutrition, leads to some interesting rank reversals in the country league table. With stunting, for example, focusing on the achievement index moves Egypt (a low-inequality country) from sixth position to fourth, higher than Brazil and Russia (two countries with high inequality).

Socioeconomic inequalities in child malnutrition in the developing world

In its 2000 World Health Report (WHR), the World Health Organization argues that a key dimension of a health system's performance is the fairness of its financing system. This paper provides a critical assessment of the index of fairness of financial contribution (FFC) proposed in the WHR. It shows that the index cannot discriminate between health financing systems that are regressive and those that are progressive, and cannot discriminate between horizontal inequity on the one hand, and progressivity and regressivity on the other. The paper compares the WHO index to an alternative and more illuminating approach developed in the income redistribution literature in the early 1990s and used in the late 1990s to study the fairness of various OECD countries' health financing systems. It ends with an illustrative empirical comparison of the two approaches using data on out-of-pocket payments for health services in Vietnam for two years - 1993 and 1998. This analysis is of some interest in its own right, given the large share of health spending from out-of-pocket payments in Vietnam, and the changes in fees and drug prices over the 1990s.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/hec.685

Adam Wagstaff

Papers

The economic consequences of health shocks

Efficiency Measurement in the Public Sector: An Appraisal

Socioeconomic inequalities in child malnutrition in the developing world

Reflections on and alternatives to WHO's fairness of financial contribution index.

Child health on a dollar a day: some tentative cross-country comparisons.