_45_ 23. Meermnan presents the results as expenditure benefits per household in each decile as a percentage of average household per capita income for all households in the sample. Thus, he has sirnply normalized total benefits or divided total benefit per household by a constant (average household income). Thus, the distribution of benefits is on a total basis rather than as a percentage of income.

# 24.

For instance, Meerman finds that out-of-pocket costs, such as uniforns, shoes, lunch, transportation, books and supplies, amount to 13 percent of household income in the first income quintile and 11 percent of household income in the second income quintile.

25. Obviously there are a wide range of policy altematives and we do not pretend to summarize them here. For a good summary of the policy options see Psacharopoulos, Tan and Jimenez (1986), Jimenez (1986), (1987) and (1989), and Mingat and Tan (1985), (1986a), and (1986b). For a detailed discussion of the role of education in development, see Psacharopoulos and Woodhall (1985) and Tan and Mingat (1989). Psacharopoulos (1985) also examines the return to education.

26.

TeclnicaLly, if one adopts a merit goods perspective, the relevant question is not how government health benefits affect the post-fisc income distribution, but instead how such benefits affect the post-fisc distribution of health or health care (Foxley, 1979, pp. 106110).

27.

Of course, average cost may be a poor proxy for marginal benefit. For example, if marginal cost equals average cost, user fees set below marginal cost suggest that individuals will utilize care until marginal benefit is below marginal and average cost. There may also be an insurance value associated with health care, which is not represented in the average cost measure of health care benefits.

28. However, note that higher fees paid by the rich are often associated with higher quality of care, so that studies using average cost per visit should probably use average fee per visit in calculating household benefits (Meerman, pp. 159-160). Also, see Selowsky (p. 81) for the appropriate treatment of premium contributions to public health care plans.

29. Unfortunately Meesook's data do not pennit her to distinguish between govemment and private hospital care. Nevertheless, even if all private care were consumed by the well-todo, the distribution of public hospital subsidies would still be pro-rich overall.

30. Of course, excessive migration to urban areas can also cause crowding, unemployment, poverty-stricken squatter colonies, and civic unrest (Williamson, 1988, surveys this literature).

31. For instance, Meennan allocates land settlement costs to resettled farmers, and Foxley et al. allocate agricultural credit to medium and large farmers.

32. When survey data on utilization exist but there are no corresponding data on program costs, researchers might folow Meerman and Selowsky, both of whom derive useful insights from utilization data alone.

33. That is, it can be argued that forward shifting to consumers of agricultural benefits in developing countries does not exist when the govenment acts to maintain a fixed consumer price (e.g., Meerman, p. 234). In this case, however, there are really two government actions, an agricultural program and a price program, so that one should explicitly examine the incidence effects of both.