O’Donnell, Doorslaer, Wagstaff, Lindelow (2005) wrote a handbook Analyzing Health Equity Using Household Survey Data, to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity. And, stimulate yet more analysis in the field of health equity, especially in developing countries. Lead to a more comprehensive monitoring of trends in the health fair, a better understanding of the causes of these inequalities, more extensive evaluation of the impact of development programs on equity medical part, and the policies and programs more effective to reduce inequalities in the health sector. In their book, they use many methods to evaluate the inequity, but in summary they use two indices: Concentration index and Kakwani index to evaluate.
To understanding the definition of equity, Culyer and Wagstaff (1993) have published thearticle researched the equity in USA. Oneof objectivesistoclarifythemeaningofthetwodefinitionsofequitywhichseemleastclear:
“distributionaccordingto need” and “equalityof access”. Authors also concludethatthe
principlesof“distributionaccordingtoneed”and“equalityofaccess”have
been,andcontinuetobe,interpretedinanumberofdifferentways,andthatthevariousinterp retationsaremutuallyincompatible.
To compare the inequity in a developed and a developing country, Wagstaff and Doorslaer (1994) useddatasets VHLSS 1998 (Viet Nam) and NPHS 1994 (Canada)in the paper which outlines a framework for comparing empirically overall health inequality and socioeconomic health inequality. The framework, which is developed for both individual-level data and grouped data, is illustrated using data on malnutrition amongst Vietnamese children and on health utility amongst Canadian adults. In both cases, socioeconomic inequalities account for around 25%
of overall inequality.
To examine which indices used in analyzing inequity, Kakwani, Wagstaff, Doorslaer (1997) used the dataset of Dutch HIS 1980/81 which clarifies the relationship between two widely used indices of health inequality and explains why these are superior to other indices used in the literature. It also develops asymptotic estimators for their variances and clarifies the role that demographic standardization plays in the analysis of socioeconomic inequalities in health.
To present evidenceonincome-relatedinequalitiesinself-assessedhealthin nine industrialized countries, Doorslaer,Wagstaff and partners (1997) used the datasets of Sweden, Switzerland, UK,US, Germany among1980s-1990s in their study.Health interview survey data were used to construct concentration curves ofself- assessedhealth,measuredasalatentvariable.Inequalitiesinhealth
favoredthehigherincomegroupsandwerestatisticallysignificantinallcountries.
Inequalities were particularly high intheUnited StatesandtheUnitedKingdom.
Amongst otherEuropeans,Sweden,FinlandandtheformerEastGermanyhadthelowest inequality.Across countries, a strongassociation was found betweeninequalitiesinhealth andinequalitiesinincome.
To answer the question How is the inequity in Asia? O’Donnell, Doorslaer and partners (2005) studied the inequalities which described the structure and the distribution of health care financing in 13 territories that account for 55% of the Asian population. Survey data on household payments are combined with Health Accounts data on aggregate expenditures by source to estimate distributions of total health financing. In all territories, high-income households contribute more than low-income households to the financing of health care. In general, the better off contribute more as a proportion of ability to pay in low and lower-middle income territories. The distribution of out-of-pocket (OOP) payments also depends on the level of development. In high-income economies with widespread insurance coverage, OOP payments absorb a larger fraction of the resources of low-income households. In poor economies, it is the better off that spend relatively more OOP.
This contradicts much of the literature and suggests the poor simply cannot afford to pay for health care in low-income economies. Among the high-income territories, Hong Kong is the one example of progressive financing arising from reliance on taxation, as opposed to social insurance, and an ability to shield those on low- incomes from OOP payments. Thailand has a similar financing structure and achieves a similar distributional outcome.
To check which factors mostly affected to health care inequity, many writers used decomposition method for their researches, I remind that only factors that CIs are equal and greater than 0.2, mean that moderate and severe inquality, then for decomposition analysis. Below are some studies on the world.
Wagstaff, Doorslaer, Watanabe (2003) researched the decomposingthe causes of health sector inequalities with an application to malnutrition inequalities in Vietnam, they used VHLSS 1993 and 1998 for their study. Inequalities across the income distribution in a variable y can be decomposed into their causes, and changes in inequality in y can be decomposed into the effects of changes in the means and inequalities in the determinants of y, and changes in the effects of the determinants
of y. Inequalities in height-for-age in Vietnam in 1993 and 1998 are largely accounted for by inequalities in consumption and in unobserved commune-level influences. Rising inequalities are largely accounted for by increases in average consumption and its protective effect, and rising inequality and general improvements at the commune level.
To compare inequality decomposition from Vietnam and other countries, Wagstaff (2005) also researchedinequality decomposition and geographic targeting with applications to China and Vietnam.Inthis research they used dataset VHLSS 1998. The study answer the question How far are income-related inequalities in the health sector due to gaps between poor and less poor areas, rather than due to differences between poor and less poor people within areas? This note sets out a method for answering this question, and illustrates it with two empirical examples.
The disproportionate accrual of health subsidies to Vietnam’s better-off is found to be largely due to the fact that richer provinces have larger per capita subsidies, while pro-rich inequalities in health insurance coverage in rural China are found to be largely due to the fact that better-off villages have been more successful at preventing the collapse of their insurance schemes.
As a similar research in Asian country, Chai Ping Yu, Whynes,Sach (2008) have studied health care finance in Malaysia, they used datasets HE 92/93 for this study.The primary purpose of this paper was to comprehensively assess the equity of healthcare financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Results showed that Malaysia's predominantly tax- financed system was slightly progressive with a Kakwani's progressivity index of 0.186.
Tran Van Tien, Hoang Thi Phuong, Inke Mathauer and Nguyen Thi Kim Phuong (2011) drawed the general picture about equity in Viet Nam through the report “A Health Financing Review of Viet Nam with a focus on social health insurance”. This report describes the findings of an assessment of the current health financing system in Viet Nam. The report provides a detailed analysis of Viet Nam’s health financing system by assessing the system’s institutional design and organizational practice in relation to the key health financing functions of resource collection, pooling and purchasing and how these affect the performance of the system. On this basis, it is possible to identify appropriate changes ininstitutional design and organizational practice that contribute to progress towards universal coverage.
With all international and domestic studies, researching for equity especially in health care finance becomes imperatively, Viet Nam is a developing country, these issues even more important. The author want to answer the question whether inequity in health care finance in Vietnam deserve to the issue to examine. And how the level of that problem compared to other countries? To supply to policy-maker a look to resolve the present problem.