AFRO-NETS> Free Government Health Services: Are They the Best Way to Reach the Poor?

[Claudio Schuftan <aviva@netnam.vn>]

Free Government Health Services: Are They the Best Way to Reach the Poor?
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Davidson R. Gwatkin, March, 2003, World Bank
 
Available online as Adobe PDF file (13 pp. 51 kB) at:
http://poverty.worldbank.org/files/13999_gwatkin0303.pdf
 
Equity is a frequently stated justification for government involve-
ment in the health care market. This is often taken to mean directly 
providing all segments of the population with a wide range of govern-
ment-operated health services at no cost: free universal care.
 
Yet a look at the record suggests that this goal all too often re-
mains elusive, especially in poor countries; that governments in fact 
serve only a some of the population; and that the people served are 
disproportionately concentrated among the better-off. When this hap-
pens, government health services, far from promoting equity, work 
against it.
 
The purpose of this chapter 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 re-
source allocation and purchasing. The first section summarizes the 
information known about the distribution of benefits from government 
health services across social groups in order to document the regres-
sive 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.
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