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The World Bank Economic Review Advance Access published online on January 24, 2007
The World Bank Economic Review, doi:10.1093/wber/lhl009
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© The Author 2007. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / THE WORLD BANK. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia

Owen O'Donnell, Eddy van Doorslaer, Ravi P. Rannan-Eliya, Aparnaa Somanathan, Shiva Raj Adhikari, Deni Harbianto, Charu C. Garg, Piya Hanvoravongchai, Mohammed N. Huq, Anup Karan, Gabriel M. Leung, Chiu Wan Ng, Badri Raj Pande, Keith Tin, Kanjana Tisayaticom, Laksono Trisnantoro, Yuhui Zhang, and Yuxin Zhao

JEL Codes: H22, H42, H51

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor effectively from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector alternatives.


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