A Systematic Review of Equity in Healthcare Financing in Low- and Middle-Income Countries

OBJECTIVES: The present systematic review aimed to assess the healthcare financing system by studying the relevant indicators in low- and middle-income countries (LMICs). The focus of this research was on the entire healthcare system without considering any specific healthcare service or population group. This article explains the conditions of equity in people's payments for healthcare services in LMICs and focuses on the strengths and weaknesses of successful or failed healthcare systems.

METHODS: A systematic search was conducted in the existing database that included the data up to December 2016. The quantity of equity was estimated using relevant indicators and comparing the results with indicators' specific values. Narrative synthesis was then performed for the purpose of reporting the results.

RESULTS: A total of 17 articles from 14 regions, including Palestine, China, China (Heilongjiang), China (Gansu), Ghana, Hungary, Iran, Tunisia, Tanzania, Malaysia, Malawi, Zimbabwe, Uganda, and Chile met the inclusion criteria. The findings indicated that the insurance system (individual and social) is the most equitable method of financing, whereas direct payment is the most unfair method. Nevertheless, many countries still struggle with various payment methods, and people use direct payments.

CONCLUSIONS: Results revealed that several factors can affect a country's failure to establish equity in financing the health system. These factors include an increase in direct payments by people to reduce the government's share, failure to cover insurance for the entire population (and especially the poor), and problems in identifying people from low-income groups and setting rules for exempting them from taxes.