Targeted versus non-targeted strategies
Free government health services: are they the best way to reach the poor?
Alternative approaches to resource allocation and purchasing can help to ensure affordable health care for the poor
Authors:
D. Gwatkin
Publisher:
World Bank, 2003
Equity is a frequently stated justification for government involvement in the health care market. This is often taken to mean directly providing all segments of the population with a wide range of government-operated health services at no cost. Yet evidence suggests that this goal often remains elusive, especially in poor countries; that governments serve only some of the population; and that the people served are disproportionately concentrated among the better-off. When this happens, government health services, far from promoting equity, work against it.
The purpose of this document, produced by the World Bank, is to illustrate that there are many ways for governments to pursue the goal of ensuring that the poor receive adequate, affordable services through alternative approaches to resource allocation and purchasing. The first section summarises the information known about the distribution of benefits from government health services across social groups, in order to document the regressive pattern that now frequently exists and the need for significant changes in approach if the poor are to benefit. The second and third sections illustrate the kinds of changes that might be considered. [adapted from author]
