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Article

Yara Ahmed, Racha Ramadan and Mohamed Fathi Sakr

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the…

Abstract

Purpose

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Design/methodology/approach

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

Findings

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

Originality/value

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

Details

Journal of Humanities and Applied Social Sciences, vol. 3 no. 1
Type: Research Article
ISSN: 2632-279X

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Article

Nirjhar Nigam, Sondes Mbarek and Afef Boughanmi

Financing investments in a knowledge-intensive sector may be more difficult as there is a greater degree of uncertainty and asymmetries of information. This paper aims to…

Abstract

Purpose

Financing investments in a knowledge-intensive sector may be more difficult as there is a greater degree of uncertainty and asymmetries of information. This paper aims to examine whether a company’s intellectual capital (human capital, relational capital and structural capital) can serve as a quality signal in the financing of health care startups with new business models.

Design/methodology/approach

The study constructed a manual database using several paid and unpaid databases. This paper collected random data from 204 startups that obtained funding during the 2014–2017 period and used signaling theory to examine the factors that impact access to external financing for Indian health care technology startups.

Findings

This paper found that venture capitalists partly base their financing decisions on the relational capital of the startup represented by startups’ age and the average number of website visits, the presence of a syndicate of investors. Human capital variables and structural variables do not show much significant impact. This paper also find some business models show a negative impact on financing implying that investors are reluctant to invest in new technologies that carry more uncertainty and take a longer time to become profitable.

Research limitations/implications

Before concluding this paper, it is important to acknowledge the limitations of the study and some implications for future research purposes. First, the study is conducted on only 204 startups from India, and as such, it suffers from a small sample size, like many other comparable survey-based studies in entrepreneurship. Second, the results are obtained with respect to data collected from Indian startups and represent the Indian context which limits the generalization on a global level.

Practical implications

The results suggest that years of experience and prior relevant experience, do not actually impact the financing of a new venture. These results are crucial as India has a unique demographic advantage over other countries in relation to age. If young minds are adequately nurtured, this can result in innovation, entrepreneurship and job creation (which still remains as a foremost challenge for India).

Social implications

From a policy perspective, a number of implications emerge from the current study. There is a need for ameliorating the capacity of the education system in providing top-quality support including a greater focus on entrepreneurship courses and to replicate the education delivery model from top foreign institutes. The government should take this opportunity to revive the system of education and follow the methodology of elite institutes and to develop entrepreneurship spirit in other colleges and schools.

Originality/value

Financing the investments of young startups with new business models in knowledge-based sectors may be more difficult. In this paper, this paper demonstrates that startups have to effectively use and manage their intellectual assets to achieve sustainable competitive advantage. The findings of the paper emphasize the role of intellectual capital in securing financing through venture capital.

Details

Journal of Knowledge Management, vol. 25 no. 1
Type: Research Article
ISSN: 1367-3270

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Article

Chukwuedo Susan Oburota and Olanrewaju Olaniyan

The purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in…

Abstract

Purpose

The purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in health care financing sources are of immense policy concern particularly in developing countries such as Nigeria, where high-level income inequality exists, and the cost of medical care is generally financed out-of-pocket (OOP) due to limited access to health insurance.

Design/methodology/approach

The Duclos et al. decomposition model provided the theoretical framework for the study. Data were obtained from two waves of the Nigeria General Household Survey (GHS) panel, 2012–13 and 2015–16. The analysis covered 3,999 households in 2012–13 and 4,051 households in 2015–16. Two measures of health care financing: OOP payment and health insurance contribution (HIC) were used. The ability to pay measure was household consumption expenditure.

Findings

The major inequity issue induced by the OOP payments was vertical inequity. HICs created the problems of vertical inequity, horizontal inequity and reranking among households. Overall both health care financing options were associated with the worsening of income inequality both at the national and sectorial levels in the country. The operations of the NHIS need to be improved to ensuring improved health care coverage for the poor.

Originality/value

This paper fulfills an identified need to determine the income redistributive effects (REs) of the social health insurance (SHI) contribution at the national, urban and rural locations overtime.

Details

International Journal of Social Economics, vol. 47 no. 11
Type: Research Article
ISSN: 0306-8293

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Book part

Dmitry V. Didenko

This chapter sheds light on long-term trends in the level and structural dynamics of investments in Russian human capital formation from government, corporations, and…

Abstract

This chapter sheds light on long-term trends in the level and structural dynamics of investments in Russian human capital formation from government, corporations, and households. It contributes to the literature discussing theoretical issues and empirical patterns of modernization, human development, as well as the transition from a centralized to a market economy. The empirical evidence is based on extensive utilization of the dataset introduced in Didenko, Földvári, and Van Leeuwen (2013). Our findings provide support for the view expressed in Gerschenkron (1962) that in late industrializers the government tended to substitute for the lack of capital and infrastructure by direct interventions. At least from the late nineteenth century the central government's and local authorities' budgets played the primary role. However, the role of nongovernment sources increased significantly since the mid-1950s, i.e., after the crucial breakthrough to an industrial society had been made. During the transition to a market economy in the 1990s and 2000s the level of government contributions decreased somewhat in education, and more significantly in research and development, but its share in overall financing expanded. In education corporate funds were largely replaced by those from households. In health care, Russia is characterized by an increasing share of out-of-pocket payments of households and slow development of organized forms of nonstate financing. These trends reinforce obstacles to Russia's future transition, as regards institutional change toward a more significant and sound role of the corporate sector in such branches as R&D, health care, and, to a lesser extent, education.

Details

Research in Economic History
Type: Book
ISBN: 978-1-83909-179-7

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Book part

Petri Parvinen and Grant T. Savage

A common observation is that both single- and multi-payer health care systems will achieve lower overall costs if they use primary care gatekeeping. Questioning this…

Abstract

A common observation is that both single- and multi-payer health care systems will achieve lower overall costs if they use primary care gatekeeping. Questioning this common wisdom, we focus on the health care access system, that is, the way in which patients gain access to health care. Gatekeeping, the use of primary care providers to control access to more specialized physician and hospital services, has come under intense scrutiny in the United States and in Europe. The few international comparative studies that have focused on the issues of quality of care, cost containment, and patient satisfaction find weak or no support for common assumptions about gatekeeping. Hence, we examine the institutional environments in seven countries in order to: (a) define and categorize health care access systems; (b) identify the components of a health care access system; (c) explore the notion of a strategic fit between health care financing systems and access system configurations; and (d) propose that the health care access system is a key determinant of process-level cost efficiency. Drawing upon institutional and governance theories, we posit that the structure and organization of an access system is determined by how it addresses six essential questions: Who is covered? Which services are included? What are the points of access? How much time elapses before access? What are the ways of selecting among points of access? and Are services and their quality the same for everyone? This analytical framework reveals that national health care access systems vary the most in their points of access, access times, and selection mechanisms. These findings and our explanations imply that access systems are one of the only tools for demand management, that any lasting change to an access system typically is implemented over an extended time period, and that managers of health care organizations often have limited freedom to define governance structures and shape health care service production systems.

Details

International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

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Book part

Josephine Borghi, John Ataguba, Gemini Mtei, James Akazili, Filip Meheus, Clas Rehnberg and Di McIntyre

Objective – Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms…

Abstract

Objective – Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms. However, there is little evidence as to how to carry out financing incidence analysis (FIA) in lower income settings. We outline some of the challenges faced when carrying out a FIA in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings.

Methodology – FIA was carried out for tax, insurance and out-of-pocket (OOP) payments. The primary data sources were Living Standards Measurement Surveys (LSMS) and household surveys conducted in each of the countries; tax authorities and insurance funds also provided information. Consumption expenditure and a composite index of socio-economic status (SES) were used to assess financing equity. Where possible conventional methods of FIA were applied. Numerous challenges were documented and solution strategies devised.

Results – LSMS are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. LSMS consumption categories did not always coincide with tax categories for goods subject to excise tax (e.g. wine and spirits were combined, despite differing tax rates). Tobacco companies, alcohol distributors and advertising agencies were used to provide more detailed information on consumption patterns for goods subject to excise tax by income category. There was little guidance on how to allocate fuel levies associated with ‘public transport’ use. Hence, calculations of fuel tax on public transport were based on individual expenditure on public transport, the average cost per kilometre and average rates of fuel consumption for each form of transport. For insurance contributions, employees will not report on employer contributions unless specifically requested to and are frequently unsure of their contributions. Therefore, we collected information on total health insurance contributions from individual schemes and regulatory authorities. OOP payments are likely to be under-reported due to long recall periods; linking OOP expenditure and illness incidence questions – omitting preventive care; and focusing on the last service used when people may have used multiple services during an illness episode. To derive more robust estimates of financing incidence, we collected additional primary data on OOP expenditures together with insurance enrolment rates and associated payments. To link primary data to the LSMS, a composite index of SES was used in Ghana and Tanzania and non-durable expenditure was used in South Africa.

Policy implications – We show how data constraints can be overcome for FIA in lower income countries and provide recommendations for future studies.

Details

Innovations in Health System Finance in Developing and Transitional Economies
Type: Book
ISBN: 978-1-84855-664-5

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Book part

Christoph Sowada and Iwona Kowalska-Bobko

As all countries in the world, Polish health care system has to challenge four fundamental transformations: demographic, technological, epidemiological and cultural. Each…

Abstract

As all countries in the world, Polish health care system has to challenge four fundamental transformations: demographic, technological, epidemiological and cultural. Each of them generates serious threats for the sustainability of the system. The Polish society is ageing even faster than other in the European Union. For the sustainability of the system, the ageing of the population is a double challenge: on the expenditure side and on the financing side.

The Polish health care system is characterised by three negative features: under-financing of health care, misguided organisation of the health sector and health care entities and a dramatic shortage of health care professionals. The share of GDP devoted to health has remained constant over the last years at the level of 6.3%–6.7%. Poland has one of the lowest rates of practicing doctors and nurses in the EU countries. Lack of attractiveness of the medical professions caused by consistently low wages has created a huge generation gap.

Looking from the perspective of cost-effectiveness, we must to state, that the system, with its small financial outlays, provides a relatively high level of health for the population. However, it does not mean that better results could not be achieved. The majority of the public hospitals run in the form of independent public health care units that are highly inefficient and indebted. All attempts to restructure the sector and to solve the problem of arrears of the public hospitals failed so far.

To face the challenges, Poland must change its health policy. An increase in the sector's financing is needed, bearing in mind that increasing outlays alone is certainly not enough to solve all problems and secure sustainability. Deep structural and organisational changes are necessary. Unfortunately, politicians avoid making difficult but necessary decisions, e.g., drastic restructuring of the hospital sector, preferring above all to increase public spending on health.

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Article

Victor C.W. Wong and Sammy W.S. Chiu

Analyses the features, strategies and characteristics of health‐care reforms in the People’s Republic of China. Since the fourteenth Central Committee of the Chinese…

Abstract

Analyses the features, strategies and characteristics of health‐care reforms in the People’s Republic of China. Since the fourteenth Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health‐care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de‐linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi‐public health‐care insurance is able to resolve these problems. Finally, co‐operative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health‐care needs of the people.

Details

International Journal of Public Sector Management, vol. 10 no. 1/2
Type: Research Article
ISSN: 0951-3558

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Case study

Dayashankar Maurya, Amit Kumar Srivastava and Sulagna Mukherjee

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in…

Abstract

Learning outcomes

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Case overview/synopsis

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

Complexity academic level

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Supplementary materials

Teaching Notes are available for educators only.

Subject code

CSS: 10 Public Sector Management.

Details

Emerald Emerging Markets Case Studies, vol. 10 no. 4
Type: Case Study
ISSN: 2045-0621

Keywords

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Book part

James B. Davies and Michael Hoy

We adopt a standard distributional impact methodology, based on Atkinson's cost of inequality approach, to estimate the degree of implicit redistribution created through…

Abstract

We adopt a standard distributional impact methodology, based on Atkinson's cost of inequality approach, to estimate the degree of implicit redistribution created through public funding of health insurance in Canada. The first stage of the exercise is to determine the public health insurance benefits received by families of various age and composition and to add these to measured after-tax incomes. In our base case, which uses the Atkinson Mean Logarithmic Deviation as inequality index, we find that accounting for public health insurance benefits implies a reduction in inequality equivalent to 2.4% of per capita income. We then model the implications of moving to a hypothetical fully privatized system while proportionately refunding to individuals the tax revenues saved in doing so. This would give rise to a further 2.4% equivalent per capita income reduction resulting from increased inequality in the distribution of after-tax income. Thus, for this scenario, moving from public financing of health insurance in Canada to a fully privatized system implies an overall increase in inequality equivalent to a loss of 4.8% of per capita income. This corresponds to an increase of about 25% in existing inequality. Not surprisingly, the impact of publicly financed health insurance in reducing inequality is strongest for the elderly.

Details

Equity
Type: Book
ISBN: 978-0-7623-1450-8

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