Sep 15, 2016 in total 77 publications which fulfilled the criteria, based on screening of the title, were identified in the databases. In a closed economy, income is created in production with the aid of factors such as land, labor, capital, and entrepreneurship. A paradoxical situation in regressivity or progressivity of. It is the difference between a concentration index. How ready is south africa really for a national health. This is the constant growth rate that would result in the same level of social wellbeing as the observed social wellbeing. International comparisons nanak kakwani and hyun h. Son for about the last two decades, the consensus has been that economic growth is. 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. The distribution of total health sector services benefitsis prorich. The concentration index is equal to one minus twice the area under the concentration curve.
Using this and other progressivity measures, the paper i documents a decline in progressivity over the last decades and ii examines the relationship between progressivity and economic growth. Using the social welfare framework, we derive the kakwani index from sen. Results showed that malaysias predominantly taxfinanced system was slightly progressive with a kakwani s progressivity index. Red regressive 23 direct tax es indirect tax es a ll a rgentina na na na bolivia ne 0. Section iii documents the evolution of inclusive growth focusing on emerging markets and low income countries, whereas most previous studies only cover oecd countries. Data and research on social and welfare issues including families and children, gender equality, gini coefficient, wellbeing, poverty reduction, human capital and inequality.
Comparing redistributive efficiency of taxbenefit systems. D espite the efforts to improve health system equity indi. Equity in health care entails payment for health services according to the capacity to pay and the receipt of benefits according to need. A note on the maximum value of the kakwani index springerlink. It is equal to the difference between the gini index for the social.
A general class of inequality elasticities of poverty. Effects of iranian economic reforms on equity in social. Statistical software components from boston college department of economics. Using copulas to measure association between ordinal measures. Articles written in english published between january 2004 and september 2015 were searched.
The kakwani index was computed directly in a single step from convenient regression in the following form. The concentration index quantifies the degree of socioeconomicrelated inequality in a health variable kakwani, wagstaff, and van doorslaer 1997. Measuring equity in households health care payments. Health care system and health care delivery docshare. The kakwani index of tax progressivity is given by the difference between the concentration index of taxes. In recent years, a number of studies in the field of health economics have used these indicators to assess the equity in the health care system of iran 810. The redistributive effect and progressivity of taxes revisited aias. Kakwani index, inequality among the poor, aggregation functions, ow a operators, dual decomposition. 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. Then, we extend kakwanis 1993 methodology for the calculation ofinequality elasticities of poverty. Table 2 below is taken from adam wagstaff and eddy van donorslaer, equity in hatlh care finance and delivery, in a. Fiscal policy and inequality, income inequality, poverty, social assistance, taxation. Jul 28, 2018 the kakwani index computes the departure from proportionality of a progressive income tax by measuring the difference between the concentration coefficient for tax liabilities and the gini coefficient for pretax incomes. For n igeria, outofpocket payment on health i s progressive as shown by a kakwani index of 0.
This paper assesses both equity in the financing and distribution of health. Improvements are threefold with respect to kakwanis1993 works. In their seminal papers, jakobsson 1976, fellman 1976, kakwani. A negative index regressively suggests a lower proportion of income. Income inequality and poverty world bank documents. However, taxes are a much smaller proportion of total health sector financing compared with outofpocket payments. This paper discusses how the structure of the tax system affects its progressivity. In 2010, the undphpi was replaced by estimates of a multidimensional poverty index. Concentration indexes are calculated on pretax income and pretransfer income. This is also the difference between the concentration index of the tax ic x and the gini index of gross income. A positive kakwani index indicates that a health financing mechanism is progressive while a negative kakwani index indicates a financing mechanism which is regressive. If successful, the jkn will be the biggest single payer system in the world.
Who pays for and who benefits from health care services in. The undphpi aggregated deprivations in health, education, and standards of living and was estimated separately for developing undphpi1 and developed countries undphpi2. She nds a peak in tax progressivity in the early 1950s on the kakwani and suits indices and a strong decline till the late 1970s followed by a relatively steady trend till 1997. The impact of fiscal policy on inequality and poverty in chile sandra martinezaguilar, alan fuchs, eduardo ortizjuarez, and giselle del carmen ceq working paper no. Defined as twice the area between the concentration curve for a payment for taxes or health care etc. The kakwani index is the di erence between the concentration index and the gini index. Library of congress cataloging in publication data.
R2 is the sample variance of the fractional rank variable, h is the health payment variable. This index measures the extent to which health care financing system digresses from the equity 7. In their measure of inequality, the covariance between health status and the rank of individual income in the income distribution is used. Measuring the redistributive impact of taxes and transfers. The views expressed in cgd working papers are those of the authors and. A measure of the progressivity or regressivity of health care payment systems. This deidentified version of our data set is sufficient to support all the findings of this study. The kakwani index is a measure of the progressivity of a social intervention, and is used by. It is equal to the difference between the gini index for the social intervention, and the gini index for incomes before imposition of the policy intervention. Growth, inequality, and poverty reduction in developing. Only studies which measured the kakwani index of progressivity in at least two time points were included. Kakwani index has been extensively used in the literature to analyze equity in taxation and government expenditures.
Incomes are more equally distributed and fewer people are poor where social spending is high. Pdf decompositions for the kakwani poverty index researchgate. The kakwani index for both taxes combined is equal to. Agricultural modernization, structural change and propoor. A primer martin ravallion development research group, world bank. Jun 09, 2008 the kakwani index was computed directly in a single step from convenient regression in the following form. In reference to the kakwani index, for example, if the nhif is to become the predominant source of healthcare financing, then it implies that the contribution scale may need adjustment to. We compute the concentration index of the number of visits in wave t, cit, using the convenient covariance formula for example, kakwani, 1980. The proposed methodology is applied to thailand, using the 1998 socioeconomic survey. Outofpocket payments, vertical equity and unmet medical. Propoor index of the income components the income components provide the information about the components of a fiscal system.
Then, we extend kakwani s 1993 methodology for the calculation ofinequality elasticities of poverty. It is named after the economist who first proposed and used it, nanak chand kakwani. It is a revised and upgraded version of inequal published by edward whitehouse in stb23. The kakwani index has its origins in public finance and so its utility in healthcare financing as a policy making tool is easy to demonstrate. 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. A paradoxical situation in regressivity or progressivity.
Consumption taxes and income inequality an international. Income inequality and poverty all documents the world bank. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and outofpocket payments. This author focuses on health achievement and suggests an achievement index that. Measurement of horizontal inequity in health care utilisation.
A note on the maximum value of the kakwani index request pdf. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. Correcting the bias in the concentration index when income is. Colombia launched its national multidimensional poverty measure in 2011. In addition, micro datasets are needed to apply regression based decomposition techniques for the concentration index wagstaff et al. It has been used, for example, to measure and to compare the degree of socioeconomic related inequality e. An important property of the kakwani index is that it is additively separable. The kakwani index uses the gini framework to measure how progressive a social intervention is. The kakwani index for outofpocket payments was equal to 0. The kakwani index computes the departure from proportionality of a progressive income tax by measuring the difference between the concentration coefficient for tax liabilities and the gini coefficient for pretax incomes. If transfers decrease with income and taxes increase with income, the kakwani transfer is negative and kakwani tax is positive. There are nonetheless increasing variations in the. Equitable financing is a key objective of health care systems.
International journal for equity in health biomed central. Income taxation in latin america and the caribbean. These national accounts ratios are stored in a stata data file, and scaling. Concentration indices measure inequality in one variable over the distribution of another kakwani, 1977. In case of maximum progression, that is a situation in which only one taxpayer faces the overall tax burden, the index reaches its theoretical maximum value, given by 1 minus. This index may be useful in making the government fiscal system more beneficial toward the poor through marginal reforms. Pramod kumar chaubey egyankosh, ignouindira gandhi national open university. In uganda, as in many african countries, although equity is extolled in government policy documents, not much is known about who pays for, and who benefits from, health services. Kakwani index is equal twice the area between the lorenz curve and the concentration curve of a tax, or transfer. The oop has been considered regressive kakwani index with a negative value in nature.
Kakwani defines hisher index as being c g, where c is the concentration index and g is kakwani s gini index. In case of maximum progression, that is a situation in which only one taxpayer faces the overall tax burden, the index reaches its theoretical maximum value, given by 1. It suggests a measure of progressive capacity of tax systems, based on the kakwani index, but independent of pretax income distributions. Perhaps one of the most ambitious examples of this is indonesias national health scheme known as the jkn which is designed to make health care available to its entire population of 255 million by end of 2019.
The kakwani index is a measure of the progressivity of a social intervention, and is used by social scientists, statisticians, and economists. The kakwani index was computed directly in a single step from convenient regression in the following form 15. This has led to the lack of access to health care as well as limited to no health care expenditure risk coverage for the poor. Thus, by computing the kakwani index for each health financing mechanism, weighting it for the contribution of that financing mechanism in the total and summing them up, one can obtain the overall progressivity of the health system. The findings indicate that laborusing technological change generates absolute and relative propoor effects whereas. The kakwani index is determined by the pattern of consumption. Consequently, the poor are restricted to basic health services. Stata module for decomposition of progressivity measurements. Philippe van kerm statistical software components from boston college department of economics. If the kakwani index is normalized, an ordered weighted averaging. November 15, 2005 document of the world bank report no. Out of pocket payment oop, a source with high share to total health expenditure, is an inequitable mechanism for health financing.
Improvements are threefold with respect to kakwani s1993 works. Introduction since the early 2000s, chile adopted an integral approach to social policy to gradually incorporate a set of multisectorial programs and interventions that sought to serve as a buffer to negative shocks. Graphically the kakwani index is represented as twice the area between. 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. Equity in health financing as one main aspect of health equity plays an essential role on the path toward universal health coverage. The paper concentrates on the poverty measure proposed by kakwani. What links here related changes upload file special pages permanent. Using this and other progressivity measures, the paper i documents a decline in progressivity over the last decades and ii examines the relationship between. Is kakwani s idea of a gini index ok for describing progressiveness. The impact of fiscal policy on inequality and poverty in chile.
The gini index and its intercept significantly decreased to 0. An evaluation of health systems equity in indonesia. The negative concentration index reflects the higher mortality rates amongst poorer children. Using euromod, the euwide taxbenefit model, we document the wide. The vertical equity index v is equal to kakwani progressivity index kpt scaled by the average tax rate tx, and normalized by. This paper applies the framework for propoor analysis to welfare changes from a cgemicrosimulation model to analyze what are the better or worse models for agriculture modernization, and to estimate the contribution of growth and redistribution to changes in poverty in drc.
Kakwani derived an aggregate growth rate for the whole period using the concept of an equivalent uniform growth rate. Moreover, we also complement the work of wagstaff wagstaff 2002. Using copulas to measure association between ordinal. The kakwani index of tax progressivity is given by the difference between the concentration index of taxes and the gini coefficient of income. Dec 17, 2019 equity in health financing as one main aspect of health equity plays an essential role on the path toward universal health coverage. In this section, we derive a propoor index for the ith income component. From a policy point of view, it is important to know to what degree a particular income component is propoor or antipoor. The index disaggregation by group, geographical location or type of deprivation facilitates the evaluation of public policies. The concentration index is the scaled covariance between the health of the individual and their rank in the income distribution. Complementary material the database, containing the above variables, should be accompanied by the following three additional documents in order to support not only the calculation of the. Many low and middle income countries are implementing reforms to support universal health coverage uhc. This is the difference between the concentration index of taxes and an inequality index such as the gini index of gross incomes.
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