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Health financing equity and universal coverage in Fiji – A systems-wide assessment
Background: The goal of making health care more accessible through the universal health coverage concept continues to receive attention worldwide. Fiji is an upper middle income country in the Pacific islands with a gross national income per capita of $4,870 and a population of nearly 900,000. It is one of the largest and most developed economies in the Pacific islands. This study assesses the distribution of health financing benefits and burden across socioeconomic groups in Fiji. It aims to provide evidence on equity of the current health financing system to inform the debate about pathways to universal coverage.
Methods: The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden. It uses primary data from a cross-sectional household survey for the assessment of the distribution of health care benefits and secondary data from the 2008-2009 Fiji Household Income and Expenditure Surveys to assess how the health financing burden is distributed.
Findings: More than 70% of public subsidy for health in Fiji is concentrated in hospital care. Government hospital outpatient departments accounted for nearly 47% of total health subsidy while inpatient care accounted for 30%. Across all government health facilities, the distribution of subsidy was pro-poor with negative concentration index (CI). Around 61% of subsidy for nursing stations (CI = -0.563) and 26% for inpatient care (CI = -0.128) accrued to the poorest 20% of the population. Private facility subsidies were distributed in favour of richer Fijians. The burden of financing the health system was significantly progressive with wealthier groups contributing disproportionate shares of income across all financing sources. Indirect taxes (VAT and custom taxes) were regressive with negative Kakwani indices.
Discussion/conclusion: Taken together, the results indicate Fiji is doing well in terms of poorer groups getting a fair share of benefits from public health spending and wealthier groups contributing a higher percentage of income towards funding the health system. However, challenges remain and there are important opportunities for advancement towards UHC. There is lack of information about quality of health services and the proportion of people not using the formal health system at all. Such information is necessary to accurately measure the distribution of health care benefits. Indirect taxes remain regressive despite the overall progressive health financing. There is the need for mechanisms that will cushion their effects on poorer households. The presentation will conclude with a brief comparison of the results from Fiji with those from other low and middle income countries.