How to do (or not to do) … a health financing incidence analysis

Financing incidence analysis (FIA) assesses how the burden of health financing is distributed in relation to household ability to pay (ATP). In a progressive financing system, poorer households contribute a smaller proportion of their ATP to finance health services compared to richer households. A system is regressive when the poor contribute proportionately more. Equitable health financing is often associated with progressivity. To conduct a comprehensive FIA, detailed household survey data containing reliable information on both a cardinal measure of household ATP and variables for extracting contributions to health services via taxes, health insurance and out-of-pocket (OOP) payments are required. Further, data on health financing mix are needed to assess overall FIA. Two major approaches to conducting FIA described in this article include the structural progressivity approach that assesses how the share of ATP (e.g. income) spent on health services varies by quantiles, and the effective progressivity approach that uses indices of progressivity such as the Kakwani index. This article provides some detailed practical steps for analysts to conduct FIA. This includes the data requirements, data sources, how to extract or estimate health payments from survey data and the methods for assessing FIA. It also discusses data deficiencies that are common in many low-and middle-income countries (LMICs). The results of FIA are useful in designing policies to achieve an equitable health system. L’analyse de l’incidence du financement (FIA) évalue comment la charge du financement de la santé est répartie par rapport à la capacité des ménages à payer (ATP). Dans un système de financement progressif, les ménages les plus pauvres contribuent une proportion plus faible de leur ATP pour financer les services de santé par rapport aux ménages plus riches. Un système est régressif lorsque, proportionnellement, les pauvres contribuent plus. Le financement équitable de la santé est souvent associé à la progressivité. Pour réaliser une FIA complète, il est nécessaire de disposer de données détaillées d’enquêtes auprès des ménages, avec des informations fiables à la fois sur une mesure cardinale de l’ATP des ménages et sur des variables, afin d’en extraire les contributions aux services de santé via les taxes, l’assurance-maladie et les paiements directs. En outre, pour évaluer la FIA globale, il est nécessaire de disposer de données relatives à toutes les sources de financement