7 The degree of progressivity is often expressed

in terms of the Kakwani index.22 A progressive healthcare financing system typically has a positive Kakwani index while regressive and proportional systems have negative selleck bio and zero indices, respectively.8 A key limitation of progressivity analysis, as indeed of BIA and other such quantitative measures of healthcare financing equity, is that they offer little explanation as to why a distribution is progressive or regressive. In recent years, several qualitative studies have explored the factors influencing the distribution of healthcare financing burden and benefits to help identify the reasons

behind the shape of the distribution.8 23 This study Fiji and Timor-Leste, like many LMICs, are committed to the principle of UHC.24 25 In Fiji, the Ministry of Health (MoH) affirms the right of every citizen, irrespective of geographical location, cultural background or economic status, to equal access to a national health system that provides health services for all in need of care.24 26 In Timor-Leste the National Health Sector Strategic Plan 2011–2030 (p.19) clearly stipulates that the “government shall ensure equal access to quality healthcare according to the needs of individuals with the same health conditions.”25 One of the specific health goals of the government is to maintain comprehensive primary and secondary

care services that are of good quality and accessible to all Timorese in the next 20 years (until 2030). To achieve the goal of providing quality healthcare to all citizens, the governments of Fiji and Timor-Leste are seeking ways of reforming healthcare financing. Health services in the public sector in both countries already remain largely free. In Fiji, the government has endorsed a proposal to increase total government health expenditure to at least 5% of Gross Domestic Product (GDP) with the express aim of expanding access to quality services.26 It has also floated the idea of implementing a social health insurance scheme, although a government feasibility study in 2005 Carfilzomib suggested it would be difficult to attract significant enrolment with such a scheme.27 In Timor-Leste, reforming the provision of healthcare and its financing is high on the agenda. There have been efforts by the MoH since 2007 to roll out a Basic Services Package (BSP) and Hospital Services Package (HSP) with the explicit aim of achieving universal coverage.28 A costing study of primary and hospital care services to assess the level of resources required to finance the health sector has been carried out.