@article{fdi:010084356,
  title = {{H}ow equitable is health spending on curative services and institutional delivery in {M}alawi ? {E}vidence from a quasi-longitudinal benefit incidence analysis},
  author = {{R}udasingwa, {M}. and {Y}eboah, {E}. and {R}idde, {V}al{\'e}ry and {B}onnet, {E}mmanuel and {D}e {A}llegri, {M}. and {M}uula, {A}. {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {M}alawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of {U}niversal {H}ealth {C}overage ({UHC}) acquired global popularity. {S}everal evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. {U}nderstanding the distributional impact of health spending over time due to these policies has received limited attention. {O}ur study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016. {M}ethods {W}e relied on a {B}enefit {I}ncidence {A}nalysis ({BIA}) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. {W}e used data from household surveys and {N}ational {H}ealth {A}ccounts. {W}e used a concentration index ({CI}) to determine the health benefits accrued by each socioeconomic group. {R}esults {S}ocioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. {B}etween 2004 and 2016, the inequality in public spending on curative services decreased from a {CI} of 0.037 ({SE} 0.013) to a {CI} of 0.004 ({SE} 0.011). {W}hiles, it decreased from a {CI} of 0.084 ({SE} 0.014) to a {CI} of 0.068 ({SE} 0.015) for overall spending in the same period. {F}or institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a {CI} of 0.032 ({SE} 0.028) to a {CI} of -0.057 ({SE} 0.014) and from a {CI} of 0.036 ({SE} 0.022) to a {CI} of 0.028 ({SE} 0.018), respectively. {C}onclusions {T}hrough its free healthcare policy, {M}alawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. {O}ur findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection.},
  keywords = {{B}enefit incidence analysis ; health spending ; inequality ; health care ; utilization ; {M}alawi ; {MALAWI}},
  booktitle = {},
  journal = {{I}nternational {J}ournal for {E}quity in {H}ealth},
  volume = {21},
  numero = {1},
  pages = {25 [12 ]},
  year = {2022},
  DOI = {10.1186/s12939-022-01624-5},
  URL = {https://www.documentation.ird.fr/hor/fdi:010084356},
}