1. Reaching the Poor Conference, February 24, 2004 1 Benefit Incidence Analysis Abdo Yazbeck Lead Health Economist World Bank Institute

2. 2 $ $ $ Who benefits? services

3. 3 A very crude but politically powerful way of measuring who is gaining from government spending It simply combines two empirical facts: –Who is using the services –The cost to the government of making the services available Data intensive Benefit Incidence

4. 4 India BIA Source: NCAER, New Delhi, India

5. 5 Strong Rural Inequality

6. 6 By Level of Care

7. 7 State-Level Findings: Benefit Incidence

8. 8 BIA Data Requirements Household Survey Data: –Service Use –Ability to group –Out-of pocket payment (fees) Facility Cost Data: –Unit cost of service delivery –Ability to desegregate by level of care, type of service, and/or geographic location

9. 9 Steps Group users by socioeconomic category –Income, sex, residence, tribe or caste, etc. Determine service use by group Calculate the unit cost for the service Subtract the out-of-pocket fees from cost Multiply the net unit cost by the group service use to determine group benefit

10. 10 Vietnam Safe Motherhood Examining the benefits from delivery and antenatal services by income group Income groups are divided into five (quintiles) Five service delivery levels in Vietnam: –Central Hospital –Provincial Hospital –District Hospital –Polyclinic –Commune Health Center

11. 11 Benefit Incidence Math Total Benefit for each group = Utilization * Net Unit Cost.

12. 12 Data by Income Group

13. 13 Do the Math Hint: First calculate the delivery benefits, then calculate the benefits from antenatal visits, then add the two.

14. 14 Utilization * Net Unit Cost For Deliveries, the poor: 225 * (511,000 – 71,773) = 98.8 Million For Deliveries, the rich: 741 * (511,000 – 60,734) = 333.6 Million For antenatal care, the poor: (225*1.27)*(61,000-802) = 17.2 Million For antenatal care, the rich: (741 *2.51)*(61,000-5,239) = 103.7 Million Total, poor 98.8 + 17.2 = 116 Million Total, rich 333.6 + 103.7 = 437.3 Million

15. 15 Results Question: What are possible policy implications of these findings?