Title: Is public health expenditure in Ecuador progressive or regressive?

Authors: Gustavo Angeles, Antonio J. Trujillo, Alexandra Lastra

Addresses: Department of Maternal and Child Health, University of North Carolina at Chapel Hill, USA. ' College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA. ' Secretaria Tecnica del Frente Social, Quito, Ecuador

Abstract: This paper uses a benefit incidence analysis (BIA) to evaluate whether public health expenditure in Ecuador is regressive or progressive. This paper overcomes several limitations of previous BIA analyses in developing countries: a) it develops a framework to allocate the operational and administrative government expenditures among providers at a centralised level according to their level of activity; b) it uses a household health survey in which an individual|s consumption of medical care can be tied to a specific health provider. We rank the economic status of medical care users according to the consumption per adult equivalent, and using an index obtained from the availability of durable goods in the household. The findings suggest that the Ministry of Public Health expenditure is progressive, while the Ecuadorian Social Security Institute expenditure is regressive. We offer policy suggestions to increase the efficiency and equity of public health expenditures in Ecuador.

Keywords: benefit incidence analysis; BIA; Ecuador; health expenditures; health disparities; public health; medical care users; socio-economic status; government subsidies; developing countries; healthcare; public policy.

DOI: 10.1504/IJPP.2007.012903

International Journal of Public Policy, 2007 Vol.2 No.3/4, pp.186 - 216

Published online: 23 Mar 2007 *

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