This can be explained by new pit legislation in 2005, and further changes in 2008 and 2010. Nankhonde kasonde for support in editing and production. Equitable financing is a key objective of health care systems. Measuring the impact of fiscal policy on inequality and poverty. It suggests a measure of progressive capacity of tax systems, based on the kakwani index, but independent of pretax income distributions. Myanmars national health plan nhp for 20172021 has laid out the vision of achieving universal health coverage uhc by 2030the nhp aims to improve the delivery of health services and. The vertical equity index v is equal to kakwani progressivity index k. While the kakwani measure is a form of differences and the decomposition is a weighted average of the differences of the decomposed components of the concentration index and gini coefficient, the. P scaled by the average tax rate x t, and normalized by x.
A guide to estimating the impact of fiscal policy on inequality and poverty, brookings institution press and tulane university, forthcoming. The kakwani index is also equal to the concentration index for payments minus the. Jun 27, 2011 other methods like the suits index could be used but the kakwani index is more popular and widely used in this type of analysis 8,21. Pdf since sens seminal article in 1976, it is very known that every poverty measure should be sensitive to the three. Income redistribution in the european union springerlink. If we rank households based on emissions and compute the degree of inequality, we are getting the simple gini index of household emissions and not the. Jun 09, 2008 the kakwani index was computed directly in a single step from convenient regression in the following form. The kakwani index is defined as twice the area between the lorenz curve for gross consumption expenditure atp or ses and the concentration curve for health care payments 9,22. For example, wagstaff, van doorslaer and paci 2 proposed this measure as a measure of health inequality and wagstaff and van doorslaer 19 provided an interpretation and empirical illustrations. Summary indices concentration index, kakwani index and gini coefficient were obtained for the sources of healthcare financing. It is equal to the difference between the gini index.
The argument is based on the premise that the targeting ef. Sabine alkire in response to kakwani argues that it is not the cause of poverty that matters, but what is actionable by public policy. Her areas of interest are advanced algorithms and machine learning. Ten years after the creation of the portuguese national. Outofpocket payments, vertical equity and unmet medical. He has experience in all aspects of this area including bunion surgery, minimally invasive foot surgery, arthritis, ankle replacement and revision ankle replacement, sports injuries and ankle arthroscopy. Vertical inequity was then measured through the kakwani index ki, which is the most widely used measure of progressivity in financing of a health system. Kakwani index 0 pre5transferlorenz curve 15 fiscal system with mul1ple intervenons 16 fiscal policy and inequality. Equitable financing, outofpocket payments and the role.
The gini coefficient and concentration and kakwani indices were calculated for health insurance premiums basic and complementary. Stata module for decomposition of progressivity measurements. Introduction health financing reforms in low and middle income countries lmics over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. It is the difference between a concentration index. Kakwani index, inequality among the poor, aggregation functions, ow a operators, dual decomposition.
Public sector, governance, and accountability series includes bibliographical references and index. Viroj tangcharoensathien, international health policy program. This is the difference between the concentration index of taxes and an inequality index such as the gini index of gross incomes. Twentyseven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. Facing difficulties like increasing health burden and health inequity, china government started to promote commercial health insurance chi in recent decades. The main objective was to assess the vertical equity of outpatient outofpocket payments for. The kakwani index is a measure of the progressivity of a social intervention, and is used by. The kakwani index uses the gini framework to measure how progressive a social intervention is. The measure of the reranking effect is known as the atkinsonplotnick kakwani henceforth, apk reranking index and it is given by the difference between the aftertax gini index and the concentration index. Public expenditure analysis for citizencentered governance edited by anwar shah. Statistical software components from boston college department of economics. The term propoor growth was coined in the early 1970s by ahluwalia et al.
Kakwani indices showed a constant trend towards more regressivity 0. The decomposition of the atkinsonplotnick kakwani reranking measure 179 decompose the gini index see giorgi, 2011. Vertical and horizontal equity of funding for malaria. Oct 15, 2019 kakwani index was originally used to measure progressivity in taxation and public expenditure and was later on applied to equity issues in healthcare expenditures kakwani et al. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Fiscal redistribution in low and middle income countries. Introduction health financing reforms in low and middle income countries lmics over the past decades have focused on achieving equity in financing of health care delivery through universal health. Several policies have been proposed to curb the negative impact of alcohol misuse. Concentration indexes are calculated on pretax income and pretransfer income. Under the terms of the licence agreement, an individual user may print out a pdf of a single entry. Pdf decompositions for the kakwani poverty index researchgate.
You may also open an image file to convert it to pdf file. In contrast, excise taxes are regressive, with a kakwani index of 0. Kakwani index has been extensively used in the literature to analyze equity in taxation and government expenditures. The distributional impact of fiscal policy in south africa. Day 1 session 2a theore1cal highlights in fiscal incidence. Apart from south africa, which has witnessed a rapid development in alcohol policy, such policies are poorly developed in most african countries. Add new text, edit text, or update fonts using selections from the format list. Consider, for example, the armeyshelbycraig proposal, the progressivity of which, as measured by the kakwani index. Health system plans organization and administration. The kakwani index of progressivity is based on the trapproach and equals twice the area between the lorenz curve and the concentration curve of a tax. A measure of the progressivity or regressivity of health care payment systems. Click open file or drag and drop files to this application and then use the page tools and utilities to edit you pdf document. Development of commercial health insurance in china.
It is commonly believed that the poor are the main beneficiaries from these subsidies. Apr 10, 2017 kumudini kakwani has a masters degree in information technology from iiit bangalore. Day 1 session 2a theore1cal highlights in fiscal incidence analysis ali enami and nora lus1g ceq ins1tute, tulane university learning event on the commitment to equity methodology ceq ins1tute and the world bank washington, dc july 11, 2016. He argues for an income poverty line that reflects the cost of achieving basic human needs. It is equal to the difference between the gini index for the social. Add, replace, move, or resize images on the page using selections from the objects list. Kakwani index is equal twice the area between the lorenz curve and the concentration curve of a tax, or transfer. See the complete profile on linkedin and discover dilips connections and jobs at similar companies. Alcohol policy and taxation in south africa springerlink. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and outofpocket payments.
We would like to show you a description here but the site wont allow us. Mr kakwani is a recognised surgical trainer and has led regional and national registrar teaching courses. Assessment of equity in financing in the absence of a kakwani index. A guide to estimating the impact of fiscal policy on. The vertical equity index v is equal to kakwani progressivity index k pt scaled by the average tax rate tx, and normalized by gx, as shown by 7. Asia pacific observatory on health systems and policies. We test this hypothesis in egypt by empirically analyzing the distribution of public healthcare subsidies using data from egypt demographic and health survey and egypt national health accounts. The debate ends, for now, with a rejoinder by kakwani. Defining and measuring fairness in financial contribution to the.
The first one is the complement to of the infant mortality rate expressed in per thousand births. A guide to estimating the impact of fiscal policy on inequality and poverty, brookings institution press and tulane. View dilip kakwanis profile on linkedin, the worlds largest professional community. This is also the difference between the concentration index of the tax ic x and the gini index. The overall and decomposed values of the kakwani index are shown in table 6, panel a. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. Equity in health care financing in low and middleincome. To summarize the extent of infant survival in a country, three indices have been defined. Philippe van kerm statistical software components from boston college department of economics. The main objective was to assess the vertical equity of outpatient outofpocket payments for lymphedema patients in france. The kakwani 1977 index of tax pro variance is between taxes and the cugressivity is defined as twice the area be mulative share of income recipients or of tween the concentration curves for taxes pretax income. Alcohol consumption accounts for over 4% of the global burden of disease and an even higher figure in developing countries. However, as for health inequality or inequality of medical expenditures, some researchers have applied the kakwani measure.
Measuring the redistributive impact of taxes and transfers ali enami commitment to equity institute nora lustig commitment to equity institute rodrigo aranda commitment to equity institute this paper is a chapter in nora lustig editor, commitment to equity handbook. It is a revised and upgraded version of inequal published by edward whitehouse in stb23. Using this and other progressivity measures, the paper i documents a decline in progressivity over the last decades and ii examines the relationship between. If transfers decrease with income and taxes increase with income, the kakwani transfer is negative and kakwani tax is positive. Kakwani index will be positive and when health system contributions are regressive. The tax progressivity of pit, measured by the kakwani index, increased sharply in 2005 as compared to 2004 and somewhat less in 2016 as compared to 2005. Using the social welfare framework, we derive the kakwani index from sen. The kakwani index is the di erence between the concentration index and the gini index. Rising carbon footprint inequality in the philippines. Welcome to cutepdf editor the free cloudbased pdf editor.
This is also the difference between the concentration index of the tax ic x and the gini index of gross income. This is the difference between the concentration index of taxes and an inequality index such as the gini index. Equitable financing, outofpocket payments and the role of. Differently from the gini index, the concentration index is usually expressed as a function of the underlying concentration curve. Identify new opportunities, carry out feasibility studies, draw business plans, procure approvals. This paper is a chapter in nora lustig editor, commitment to equity. An analysis of the distributional effects of replacing the. Englebrecht our study investigates the distributional effects of replacing the current income tax system with two prototype fiat tax systems. The kakwani index is a measure of the progressivity of a social intervention, and is used by social scientists, statisticians, and economists. Chapter in lustig editor commitment to equity handbook. Jun 27, 2011 the kakwani index for measuring progressivity of health care financing. There are many ways to measure capability deprivation.
The vertical equity index v is equal to kakwani progressivity index. See the complete profile on linkedin and discover kumudinis connections. There are nonetheless increasing variations in the. Applying the propoor policy index, nanak kakwani, undp poverty centre, provided an international comparison of the propoor policies of government programmes in thailand, russia, vietnam and 17 african countries. In particular, pyatt 1976, silber 1989 and yao 1999 endorse matrix form approaches. This paper discusses how the structure of the tax system affects its progressivity. Mr raj kakwani northumbria healthcare nhs foundation trust. R 2 is the sample variance of the fractional rank variable, h is the health payment variable. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. Measuring the redistributive impact of taxes and transfers. Outofpocket payments might threaten the vertical equity of financing and generate unmet medical needs. Direct subsidization of healthcare services has been widely used in many countries to improve health outcomes. We wish you an informative and valuable reading of this issue of poverty in focus. He was president of ecineq, the international society for the study of economic inequality, between 2011 and 20.
Who benefits from public healthcare subsidies in egypt. View kumudini kakwani s profile on linkedin, the worlds largest professional community. On standard of living and infant survival in some east. Nanak kakwani proposes a multidimensional poverty concept that is causally linked to command over economic resources. She has previously worked with multiple teams at amazon. The horizontal inequity index h is a difference between the concentration coefficient of posttax income x dn and gn, normalized by gx, as in 6. He was the founding editor of the journal of economic inequality, is editor of the book series economic studies in inequality, social exclusion and wellbeing springer, and has edited several special issues of academic journals. To combine pdf image files, you may click merge pdfs on the right directly. It is named after the economist who first proposed and used it, nanak chand kakwani. Equity in health financing of guangxi after chinas universal health. In this section, we focus on a fiscal system with a single tax or transfer. Lustig, nora, editor, commitment to equity handbook.
North hoiland an analysis of the distributional effects of replacing the progressive income tax with a flat tax govind s. The kakwani index of progressivity was estimated using three national household surveys. He is also actively involved in research and has published extensively in foot and ankle surgery. In her spare time she likes to travel, read books, and cook. Vertical and horizontal equity of funding for malaria control.
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