Methods to promote equity in health resource allocation in low- and middle-income countries: an overview

TY - JOUR

T1 - Methods to promote equity in health resource allocation in low- and middle-income countries

T2 - an overview

AU - Love-Koh, James

AU - Griffin, Susan

AU - Kataika, Edward

AU - Revill, Paul

AU - Sibandze, Sibusiso

AU - Walker, Simon Mark

N1 - © The Author(s). 2020

PY - 2020/1/13

Y1 - 2020/1/13

N2 - Unfair differences in healthcare access, utilisation, quality or health outcomes existbetween and within countries around the world. Improving health equity is a statedobjective for many governments and international organizations. We provide anoverview of the major tools that have been developed to measure, evaluate andpromote health equity, along with the data required to operationalise them.Methods are organised into four key policy questions facing decision-makers: (i) whatis the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity.Benefit incidence analysis can be used to estimate the distribution of current publichealth sector expenditure, with geographical resource allocation formulae and healthsystem reform being the main government policy levers for improving equity.Techniques from the economic evaluation literature, such as extended anddistributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity.Methods from the economics literature can provide policymakers with a toolkit foraddressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings.

AB - Unfair differences in healthcare access, utilisation, quality or health outcomes existbetween and within countries around the world. Improving health equity is a statedobjective for many governments and international organizations. We provide anoverview of the major tools that have been developed to measure, evaluate andpromote health equity, along with the data required to operationalise them.Methods are organised into four key policy questions facing decision-makers: (i) whatis the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity.Benefit incidence analysis can be used to estimate the distribution of current publichealth sector expenditure, with geographical resource allocation formulae and healthsystem reform being the main government policy levers for improving equity.Techniques from the economic evaluation literature, such as extended anddistributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity.Methods from the economics literature can provide policymakers with a toolkit foraddressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings.

U2 - 10.1186/s12992-019-0537-z

DO - 10.1186/s12992-019-0537-z

M3 - Article

SN - 1744-8603

VL - 16

JO - Globalization and Health

JF - Globalization and Health

IS - 1

M1 - 6

ER -