Equity of Health Care: Empirical Studies in Iran and Australia

Mohammad Hajizadeh (2010). Equity of Health Care: Empirical Studies in Iran and Australia PhD Thesis, School of Economics, The University of Queensland.

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Author Mohammad Hajizadeh
Thesis Title Equity of Health Care: Empirical Studies in Iran and Australia
School, Centre or Institute School of Economics
Institution The University of Queensland
Publication date 2010
Thesis type PhD Thesis
Supervisor Luke B. Connelly
James R. G. Butler
Total pages 185
Total colour pages 3
Total black and white pages 182
Subjects 14 Economics
Abstract/Summary Despite constant controversy over the definition of equity in health care, there is wide agreement that an equitable health care system ensures that health care is financed according to ability to pay and distributed according to need. In fact, equity has been a stated or implied goal of health policy in many countries, including Australia and Iran. The aim of this study is to analyse the equity performance of health systems in the aforementioned countries from two main aspects: financing and utilisation. The results for the distribution of the burden of health care financing in Iran show that health care financing in Iran was progressive (equitable) over the period from 1995/96 to 2006/07. However, implementation of the Urban Inpatient Insurance Scheme (UIIS) and the Rural Health Insurance Scheme (RHIS) in 2000 and 2005, respectively, were associated with a slight deterioration in progressivity of health care financing in Iran. The results are consistent with the hypothesis that public sector activity crowds out private sector (charitable) activity and may sound a cautionary note for the implementation of such programs in low-to-middle income countries where charitable activity may be directed to providing health care to the poor at lower prices. The results for health care utilisation in Iran demonstrate that the utilisation of ambulatory and inpatient services in Iran is pro-rich and the probability of health care use for general practitioner visits, specialist visits, any physician visits, and any ambulatory care visits is higher among wealthy quintiles given that individuals needed ambulatory care. The probability of unnecessary health care use is also higher among wealthier individuals. The results indicate that health care financing in Australia is progressive over the study period even though direct payments are regressive and share a considerable proportion of health care financing. Interestingly, the results suggest that the introduction of (the universal, compulsory, health care financing scheme) Medicare in Australia, in 1984, did not have a significant effect on the progressivity of direct payments, and therefore total health care financing. However, the private health insurance policy reforms introduced by the Australian government in 1997 to 2000 were associated with a progressive impact on the indices for direct payments and total health care financing. The results of this study on the utilisation of health care suggest that the distribution of GP services, any physician visits, and hospital services in Australia were generally pro-poor whereas the distribution of specialist visits, dentist visits and any ambulatory visits were pro-rich. Based on this study's findings, the introduction of publicly funded health insurance, Medicare, in 1984 had a pro-poor impact on the utilisation of all types of health care services. The implementation of various private health insurance policies in 1997 to 2000 had a pro-rich effect on the distribution of health care utilisation in recent years. In summary, both the Iranian and Australian Governments have undertaken several steps in order to increase the availability and accessibility of health care for their citizen. This study illustrates that Australia's health system provides fairly equal access to health care services. Iran's health care system provides more unequal access. The results are largely attributable to the larger extent of public sector subsides under the Australian Medicare system, which result in zero or very low direct out-of-pocket payments for services, and also Australia's (largely) progressive taxation system. Likewise, in Iran, high income earners contribute more to health care financing. However, the distribution of health care services is not merely based on an individual's need, as their ability to pay plays a major role in the utilisation of services. Thus, although wealthier individuals in Iran pay more towards health care financing, they also consume more -- on the basis of need -- than their poorer counterparts.
Keyword Equity
Health care
Additional Notes Pages printed in colour: 103, 150 and 151

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Created: Tue, 31 May 2011, 08:18:48 EST by Mr Mohammad Hajizadeh on behalf of Library - Information Access Service