It is equal to the difference between the gini index for the social. We analyzed spending on maternity care in urban slum communities in mumbai to better understand the equity of spending and the impact of spending on household poverty. Jun 09, 2008 the kakwani index was computed directly in a single step from convenient regression in the following form. The horizontal inequity index h is a difference between the concentration coefficient of posttax income x dn and gn, normalized by gx, as in 6. Table 2, which is extracted from an excel file, shows the values for each quintile of r, q, a and fa2. In chapter 3 in this handbook, ali enami shows how these conditions are affected if.
A modified kakwani measure for health inequality health. This is also the difference between the concentration index of the tax ic x and the gini index of gross income. For example, at all india level, employment elasticity of growth in agricultural output has been found to be zero during 19939419992000 whereas it was 0. The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. The results showed that spending on srh services was highly regressive in both sites, with lower income. Decomposition of inequality change into propoor growth. In addition to estimating contributions to each financing mechanism as a percentage of consumption expenditure in each quintile, it was necessary to calculate the incidence of financing using the lorenz and concentration curves to establish whether a health care financing mechanism is progressive, regressive or. The variable of interest is binary contraceptive use 0no, 1yes. The kakwani index uses the gini framework to measure how progressive a social intervention is. Adept also outputs the kakwani index of progressivity, for each source and for total health finance. Decomposition of inequality change into propoor growth and. The kakwani index is a measure of the progressivity of a social intervention, and is used by.
The overall tax revenue of a realworld personal income tax cannot be eventually paid only by the richest taxpayer. On the one hand, oop burden increases awareness of treatment costs and limits unnecessary use of healthcare services. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and outofpocket payments. The kakwani index for measuring progressivity of health care financing.
Inequity in costs of seeking sexual and reproductive. Kakwani and pernia 2000, mcculloch, robson, and boulch 2000, ravallion and chen 2003, and son 2003. The findings indicate that laborusing technological change generates absolute and relative propoor effects whereas. New evidence on financing equity in chinas health care. Country health profile 2017 portugal contents 1 highlights 1 2 health in portugal 2 3 risk factors 4 4 the health system 6 5 performance of the health system 8 5. Vertical inequity was then measured through the kakwani index ki, which is the most widely used measure of progressivity in financing of a health system. Research on personal income tax affecting structure of resident consumption expenditure in china delong zhang college of economics, jinan university, guangzhou, china abstract the purpose of this thesis is to evaluate the impactof personal income tax on the structure of resident consumption expenditure. Vertical and horizontal equity of funding for malaria. Changes in equity in outofpocket payments during the. Consequently there are several aspects that ought to be taken into. This suggests that the fraction paying no tax has served as an effective proxy for overall tax progressivity. Our modification is to measure inequality using the ratio of the concentration index to the gini coefficient instead of the difference between them.
A note on the maximum value of the kakwani index request pdf. This can be shown to be equal to the absolute decline in the gini index for incomes, caused by the imposition of taxation. This paper applies the framework for propoor analysis to welfare changes from a cgemicrosimulation model to analyze what are the better or worse models for agriculture modernization, and to estimate the contribution of growth and redistribution to changes in poverty in drc. Decomposition of inequality change into propoor growth and mobility components.
How to do or not to do a health financing incidence analysis. We used expenditure data for maternal and neonatal care, collected during postpartum interviews. The kakwani index is a measure of the progressivity of a social intervention, and is used by social scientists, statisticians, and economists. We analysed expenditure by socioeconomic status ses, calculating a kakwani index for a range of spending categories. There is a growing focus on the goal of universal coverage in health systems. Therefore, the maximum concentration coefficient for taxes cannot be equal to 1, and, consequently, the maximum value of the kakwani index cannot be 1 minus the gini coefficient for pretax incomes, as generally described in the related literature. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The vertical equity index v is equal to kakwani progressivity index k pt scaled by the average tax rate tx, and normalized by gx, as shown by 7. The kakwani 1977 index of tax pro variance is between taxes and the cugressivity is defined as twice the area be mulative share of income recipients or of tween the concentration curves for taxes pretax income. It is a revised and upgraded version of inequal published by edward whitehouse in stb23. Catastrophic spending on srh services was calculated using the threshold of 10 % of total household income. Agricultural modernization, structural change and propoor. Pramod kumar chaubey egyankosh, ignouindira gandhi national open university.
Stata module for decomposition of progressivity measurements. Tackling income inequality the role of taxes and transfers isabelle joumard, mauro pisu, debbie bloch online first please cite this article as. These four measures can be compared in view of whether they. We also propose a measure using the gini coefficient or concentration index of consumption. A measure of the progressivity or regressivity of health care payment systems. Jun 27, 2011 the kakwani index for measuring progressivity of health care financing. We propose simple modifications for the kakwani tax progressivity measure that make it suitable for evaluating access inequality for medical services.
They are a particularly popular choice for the measurement of socioeconomicrelated health inequality wagstaff et al. Vertical and horizontal equity of funding for malaria control. Kakwani index is equal twice the area between the lorenz curve and the concentration curve of a tax, or transfer. Consumption taxes and income inequality an international. This is specially an important feature of this framework since the wellknown progressivity indices are not infallible rigorous predictors of identifying equalizing interventions enami et al. This is the difference between the concentration index of taxes and an inequality index such as the gini index of gross incomes. Measuring progressivity of health care payments introduction. Measuring the redistributive impact of taxes and transfers. Interviews were conducted in 20052006, with a sample of 1200 slum residents in mumbai india. There are nonetheless increasing variations in the. The kakwani index of progressivity is based on the trapproach and equals twice the area between the lorenz curve and the concentration curve of a tax. On the other hand, it may prevent the sick from accessing needed care.
These studies include kakwani and pernia 2000, mcculloch et. Income inequality has increased in most advanced and many developing economies over recent decades, reflecting a range of factors including globalization and technological change. Kakwani decomposition of redistributive effect core. In the case of taxprogressivity and incomeredistribution indices, there have been few references so far. The effects are more pronounced when the negative deduction is taken into account total net income instead of net of tax income with a reynolds.
For example, the world health report 2010 on universal coverage of health care 1 and the associated declaration of the world health assembly 2 urged member states to aim for affordable universal coverage and access for all citizens on the basis of equity and solidarity. The findings indicate that laborusing technological change generates absolute and relative propoor effects. Concentration indices measure inequality in one variable over the distribution of another kakwani, 1977. Equity in financing and use of health care in ghana, south. Some reduction of inequity in the distribution of informal gratuities indeed took place the kakwani index changed from. Zhang 162 oecd member countries accounted for 241, which was only. Kakwani indices yaxis depending and effective tax rates xaxis.
In this paper we introduce a new methodology to study the degree of progression as well as the redistributive and reranking effects of a personal income tax system by employing and extending the new inequality curve and index proposed by michele zenga. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Research on personal income tax affecting structure of. R 2 is the sample variance of the fractional rank variable, h is the health payment variable. In total 77 publications which fulfilled the criteria, based on screening of the title, were identified in the databases. It is the difference between a concentration index. Fairness in a countrys health financing system is a key dimension to assess a health systems performance world health organization, 2000. Use the free adobe acrobat reader to view this pdf file summary. Also shown is the sum of fa 2 across the five quintiles. As can be seen, the prereform income tax was progressive kakwani index is 0. The kakwani index was originally devised to measure the progressivity of tax systems, in which case, it would be equal to the gini concentration index for the taxes collected minus the gini index for pretax incomes. Joumard, isabelle, mauro pisu and debbie bloch 2012, tackling income inequality. A note on the maximum value of the kakwani index springerlink.
The kakwani index for outofpocket payments was equal to 0. In fact, it has been noted that equity or fairness in health financing, where households contribute to the health system according to their ability to pay atp, should form an important health system goal to promote universal health. Maternal and neonatal health expenditure in mumbai slums. A modified kakwani measure for health inequality springerlink. How to do or not to do a health financing incidence. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. The kakwani index and quintile ratios are used as measures of inequitable spending. In other words, taxes or transfers that would be classified.
The kakwani index was computed directly in a single step from convenient regression in the following form. I would like to know if theres anyone who might have a do file which computes the decomposition of the erreygers concentration index using the wealth index and education as the socioeconomic variables. Given an income distribution, the zenga curve compares the economic conditions of two exhaustive groups of population obtained by dividing. Tackling income inequality the role of taxes and transfers isabelle joumard, mauro pisu, debbie bloch online first. Hence to avoid further regressivity of oop payments with cost. Outofpocket payments, vertical equity and unmet medical. In the transition from a planned economy to a marketoriented economy, chinas state funding for health care declined and traditional coverage plans collapsed, leaving chinas poor exposed to potentially ruinous health care costs.
Sep 15, 2016 there are positive and negative consequences of the implementation of out of pocket oop payments as a source of the healthcare financing. It is named after the economist who first proposed and used it, nanak chand kakwani. Chinas personal income tax is introduced after the reform and opening up, and peoples republic of personal. Kwakwani is a mining and logging town on the berbice river in the upper demeraraberbice region of guyana, some of the world best woods for building and construction can be found here. Outofpocket payments might threaten the vertical equity of financing and generate unmet medical needs. The vertical equity index v is equal to kakwani progressivity index kpt scaled by the average tax rate tx. However, in the recent years relationship between agricultural growth and poverty reduction seems to have weakened. I have used conindex to compute the concentration index erreygers. Equitable financing is a key objective of health care systems. Decomposition of change in sgini coefficient of inequality.
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