Benevolent Doctors ? Inequity in Healthcare Access in post-soviet Tajikistan

Overview & Synopsis

After the collapse of USSR, Tajikistan overcame a devastating civil war (1992- 1997). Already under-financed at the end of the Soviet Union, the healthcare system has been severely damaged. Tajikistan has an officially universal and free access to healthcare, inherited from socialism. But after the collapse, the universality was no longer sustainable. The State allowed some facilities to charge fees according to a price list (like laboratory tests), and the habit of “thanking” the doctor has been generalized, due to the low wage of medical staff. Therefore, the debate in post-soviet studies is acute in Tajikistan. Does the out-of-pocket expenditure increase inequality, or is there an informal redistributive system due to the price-differentiation conducted by benevolent doctors? By means of innovative tools (Kakwani Progressivity Index, decomposition of concentration index), this paper measures the vertical equity in financing and the horizontal equity in access, to test the “Robin Hood” hypothesis, based on the nationally representative Tajik Living Standards Survey (2007). The main result is that the “progressivity” in financing is illusory and reflects rather the horizontal inequity in access to care, than the benevolence of doctors.