ABSTRACT
This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.
Subject(s)
Health Policy/economics , National Health Programs/economics , Social Justice , Taxes/classification , Cross-Cultural Comparison , Europe , Finland , Germany , Health Services Research , Humans , Income/statistics & numerical data , Insurance, Health/economics , Sweden , Taxes/economics , Taxes/statistics & numerical dataABSTRACT
This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.
Subject(s)
Health Care Rationing/economics , Health Status , Income , Social Justice , Developed Countries , Health Care Rationing/standards , Health Policy/economics , Humans , Regression Analysis , Self-AssessmentABSTRACT
This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same.
Subject(s)
Delivery of Health Care/economics , Health Services Accessibility/economics , Internationality , Social Justice/economics , Cross-Cultural Comparison , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , Europe , Health Expenditures/statistics & numerical data , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Services Research , Income/classification , Insurance, Health/economics , Insurance, Health/standards , Insurance, Health/statistics & numerical data , Models, Econometric , National Health Programs/economics , National Health Programs/standards , National Health Programs/statistics & numerical data , Regression Analysis , Socioeconomic Factors , State Medicine/economics , State Medicine/standards , State Medicine/statistics & numerical data , United StatesABSTRACT
This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.
