DEFINING AND MEASURING FAIRNESS IN FINANCIAL CONTRIBUTION TO THE HEALTH SYSTEM1英文

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1、DEFININGANDMEASURINGFAIRNESSINFINANCIAL1❁CONTRIBUTIONTOTHEHEALTHSYSTEMChristopherJLMurrayFeliciaKnaulPhilipMusgroveKeXuKeiKawabataGPEDiscussionPaperSeries:No.24EIP/GPE/FARWorldHealthOrganization1WewouldliketoacknowledgethesupportreceivedfromtheNationalInstituteo

2、fAgingthroughanInter-AgencyAgreementwithWHOthatwasusedtoundertakeapartofthiswork.WewouldalsoliketothankDavidEvans,JulioFrenk,EmmanuelaGakidou,PatriciaHernándezandJeanPierrePoullierforcomments,suggestionsandinputs;AnaMylenaAguilar,JuanPabloOrtizandPaolaZuñigaforo

3、utstandingresearchassistance;theteamofresearchersatWHOworkingontheWHO-NHAcalculations;andGabriellaCovinoandNankhondeKasondeforsupportineditingandproduction.1I.IntroductionOneofthechallengescommontoallsocialsystemsistoachievefairnessinthedistributionofthefinancin

4、gburden,andprotectionfromtheriskoffinancialloss.Forhealthsystems,thisgoalisofparticularimportanceandespeciallydifficulttoachieveduetothecatastrophicandunpredictablenatureofsomeexpenditures.Societieshavelongdemonstratedaspecialconcernabouthowhealthsystemsarefinan

5、ced.(Behrman1995;Londoño&Frenk1997;WorldHealthOrganization2000)Muchofthepublicdiscourseincountriesundertakinghealthsectorreformisfocusedonthedesignofhealthsystemfinancinganditsfairness.(Londoño&Frenk1997;WagstaffA&VanDoorslaerE1998)Thepurposeofthispaperistoprese

6、ntadefinition,ameasureandanindexoffairnessinfinancialcontributiontothehealthsystem.Ournotionoffairnessisnotaconcernabouttheextenttowhichcontributionstothecostofthehealthsystemacrosshouseholdsredistributeincome.Startingfromasociety’seffortstoredistributeincome,th

7、ereare,nevertheless,importantconsiderationsoffairnessthatwetrytodefineandquantify.Threeissuesarecriticaltothisconceptoffairness:avoidingcatastrophicpaymentsbyhouseholds,horizontalequityand(tosomeextent)progressivityofcontribution.Further,ourapproachseparatesfina

8、ncingfromutilisation,sothatfairnessinfinancialcontributionisdeterminedindependentlyofthehealthstatusoftheindividualorhouseholdortheuseofhealthservices.Ourdefinition,m