Master of Public Policy   Master of International Affairs  

Inequality in the finance and distribution of health

Our world is living longer and healthier – life expectancy at birth has increased from 50 years in 1950 to 73 in 2017. While policies within and outside the health domain often focus on improving the level of health, the distribution of health is often ignored in policymaking – life expectancy at birth varies from 51 years in Central African Republic to 85 years in Singapore. Not only is health distributed unequally between regions and countries, stark inequalities persist even within a country. The socio-economic gradient is well known – education, gender, income, race and occupational class all determine health: Accessibility and utilisation, as well as affordability of healthcare. While health as an outcome in itself is a goal, the financing of healthcare poses unique challenges – catastrophic expenditures on health force families into poverty in developing countries; regressive and progressive payments for health are often of interest to policymakers. Such social disparities will merit attention in future policy discourse, which will demand expertise in understanding and quantifying inequality in the finance and distribution of health, identifying its determinants and applying the correct policy levers to address these disparities.

This course will equip students with the necessary theoretical foundations in inequality in health through relevant theories, empirical literature, and case studies. Students will be able to differentiate between inequality and inequity, analyse and quantify the degree of inequality by computing inequality indices, decompose it into its determinants and visualise and present findings succinctly. The course will also familiarise students with financing mechanisms in health and equip them with the tools to assess progressivity and regressivity of health systems. Finally, policy implications based on students’ findings will be discussed, critiqued and debated.

The course is divided into two parts, each with specific learning objectives. The first section of the course conceptualises health and introduces students to health systems’ organisation and objectives. Students will learn and discuss different measures of individual and population health, understand and criticize existing measures and work towards developing new measures. While health outcomes and their determinants are important, the financing of health is equally important for policy. A special focus will be placed on the different modes of financing health in both developing and developed countries around the world. Students will learn the implications of various financing models on inequality and poverty. Finally, students will be introduced to the concept of inequality and inequity (horizontal and vertical) in health and healthcare, concentration curves and indices, and will be able to explain inequalities through decomposition. Through several examples and case studies, students will be able to explore policy options and their consequences for health and healthcare. In the second section of the course, students will learn to apply the concepts from the first part and be able to graph concentration curves and calculate concentration indices in order to measure inequality and inequity using statistical software (ADePT and Stata). They will also learn to decompose the concentration index and explain the measured inequality into factors that contribute positively or negatively to it. Students will also be able to measure progressivity or regressivity in the finance of health systems and gauge the impact of catastrophic payments on poverty.

This course is for 2nd year MIA and MPP students only.