Does the implementation of UHC reforms foster greater equality in health spending? Evidence from a benefit incidence analysis in Burkina Faso

IntroductionBurkina Faso is one among many countries in sub-Saharan Africa having invested in Universal Health Coverage (UHC) policies, with a number of studies have evaluated their impacts and equity impacts. Still, no evidence exists on how the distributional incidence of health spending has changed in relation to their implementation. Our study assesses changes in the distributional incidence of public and overall health spending in Burkina Faso in relation to the implementation of UHC policies.MethodsWe combined National Health Accounts data and household survey data to conduct a series of Benefit Incidence Analyses. We captured the distribution of public and overall health spending at three time points. We conducted separate analyses for maternal and curative services and estimated the distribution of health spending separately for different care levels.ResultsInequalities in the distribution of both public and overall spending decreased significantly over time, following the implementation of UHC policies. Pooling data on curative services across all care levels, the concentration index (CI) for public spending decreased from 0.119 (SE 0.013) in 2009 to −0.024 (SE 0.014) in 2017, while the CI for overall spending decreased from 0.222 (SE 0.032) in 2009 to 0.105 (SE 0.025) in 2017. Pooling data on institutional deliveries across all care levels, the CI for public spending decreased from 0.199 (SE 0.029) in 2003 to 0.013 (SE 0.002) in 2017, while the CI for overall spending decreased from 0.242 (SE 0.032) in 2003 to 0.062 (SE 0.016) in 2017. Persistent inequalities were greater at higher care levels for both curative and institutional delivery services.ConclusionOur findings suggest that the implementation of UHC in Burkina Faso has favoured a more equitable distribution of health spending. Nonetheless, additional action is urgently needed to overcome remaining barriers to access, especially among the very poor, further enhancing equality.

Market heterogeneity and the distributional incidence of soft-drink taxes: evidence from France

Market heterogeneity may affect the distributional incidence of nutritional taxes if households sort by income across markets with different characteristics. We use scanner data to analyse the distributional incidence of the 2012 French soda tax on Exact Price Indices that measure consumer welfare from the price and availability of soft-drinks at a local level. While the average pass-through was small—about 45 per cent—, tax incidence was significantly higher in low-income and less-competitive markets. Market heterogeneity ultimately has substantial distributional effects: it accounts for at least 33 per cent of the difference in welfare variation between low- and high-income consumers.

Revisiting the distributional impacts of water subsidy policy in Chile: a historical analysis from 1998–2015

The distributional incidence of the Chilean water subsidy scheme is revisited by analyzing its evolution from 1998 to 2015. This is one of the only means-tested water subsidies in a developing country and is frequently used as an example in policy discussions and recommendations. Many changes have been introduced in the program since its inception and at least three different targeting instruments have been used to identify needy households in the last 20 years. We find that the incidence of the subsidy is progressive but moderate, with a Gini coefficient of close to 0.3. It has also remained stable between 1998 and 2015. The errors of inclusion and exclusion have also remained stubbornly high. These incidence results are surprising given the efforts made in the Chilean welfare system to target social benefits. Possible explanations for these results are given and compared to other developing country experiences.