Background: Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. Methods: We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. Results: Most of the documents analysed do not define equity in the first place, and speak about "health inequities" in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguousespecially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rightsbut also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socioeconomic , geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. Conclusions: While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.
The purpose of the paper is to measure technical efficiency levels in 15 OECD insurance industries over the period 1983-1991 and to decompose productivity changes into technical progress and efficiency variations. We show that the growth in the productivity observed in all countries is essentially imputable to improvements in technical progress. We then try to see whether some structural national characteristics of insurance markets can partly explain the differentials in efficiency levels across countries. Reinsurance rates and market shares in OECD both seem to favor efficiency levels. The study is a step towards a comprehensive efficiency comparative study of the OECD insurance markets especially desirable in this period of increasing integration and deregulation of the market.
The purpose of this paper is to provide for both life and non life insurance a measurement of economies of scale and an assessment of productive performance of French companies. We use a translog cost function to check the presence of scale economies and a parametric approach to construct our yardstick of productive efficiency. Our panel data covers 84 life and 243 non life companies for the period 1984-89. The main findings indicate both the existence of increasing returns to scale and a wide dispersion in the rates of inefficiency across companies. Those two results are shown to be closely linked to a number of characteristics of the companies studied, particularly their institutional form.
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