Means Testing in Cost Recovery of Health Services in Developing Countries. Phase 1: Review of Concepts and Literature, and Preliminary Field Work Design

摘要

In developing country health sectors, the importance of means testing has been brought forth by increased reliance on user fees to help finance services. This paper provides a conceptual framework for understanding the role that means testing can play in promoting equity in the health sector, as well as a survey of over 60 means-tested programs worldwide. Means testing is placed in the broader context of targeting and contrasted with other targeting mechanisms. The paper examines important policy and practical issues involved in the design and implementation of means tests. For example, how are the target population and eligibility criteria defined, and how do these definitions differ from those used in income transfer programs. What are the tradeoffs between spending on benefits and spending on improved means-testing accuracy. How are outcomes evaluated. The survey of previous means-testing experience suggests certain elements of design enhance or diminish the likelihood of success. Finally, an agenda for future research is proposed.