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Funding health care: current options and future direction. Anna Dixon Research Officer. Funding health care: themes. Public sources of revenue – taxation and social health insurance Private sources of revenue – user charges and private health insurance Health and social care – complementary?.

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Funding health care themes
Funding health care: themes

  • Public sources of revenue – taxation and social health insurance

  • Private sources of revenue – user charges and private health insurance

  • Health and social care – complementary?


Proportion of tax and shi as the in western europe

100

L

80

F

NL

D

60

Percentage of total health expenditure from

GRE

40

social health insurance

B

CH

20

FIN

S

UK

IRL

P

NOR

I

E

0

DK

0

20

40

60

80

100

Percentage of total health expenditure from taxation

Proportion of tax and SHI as % THE in western Europe


Contribution of taxation to social health insurance fund income
Contribution of taxation to social health insurance fund income

  • Austria:

    • farmers fund - 23%

    • overall 0.5%

  • Belgium: 35-40%

  • France: about 60%

  • Germany:

    • farmers fund - 52%

    • overall <1%

  • Luxembourg: up to 40%

  • Netherlands: 25%


How fair is social health insurance
How fair is social health insurance? income

Upper income ceiling

% contribution

Lower income threshold

Earnings


How fair is tax

Middle income tax rate income

How fair is tax?

Top income tax rate

% contribution

Lower income tax rate

Income


Changes to social health insurance
Changes to social health insurance income

  • Universal coverage

  • Wider revenue base

  • Greater government control

  • Choice and competition


Extension of coverage germany
Extension of coverage, Germany income

  • 1883 – 10% pop covered

  • 1901 – white collar from transport and commercial

  • 1914 – domestic servants, agricultural and forestry

  • 1972 – farmers


Insurance competition
Insurance Competition income

  • Netherlands (1987)

  • Germany (1996)

  • Switzerland (1911)

  • Belgium (1945)



Differing impacts of user charges
Differing impacts of user charges income

  • The availability of supplementary insurance

  • Reducing ‘necessary’ and ‘unnecessary’ utilisation

  • Impact on prevention

  • Concerns for health - Impact on health status

  • Health as a public good and caring externalities


Voluntary health insurance is
Voluntary health insurance is… income

  • “health insurance that is taken up and paid for at the discretion of individuals or employers on behalf of individuals. VHI can be offered by public or quasi public bodies and by for profit and not for profit private organisations”

    • Mossialos and Thomson 2001


European experience
European experience income

  • Substitutive

    • Alternative to public insurance; main form of insurance cover for individual

  • Supplementary

    • may increase subscriber choice of provider and improve (speed of) access

  • Complementary

    • full or partial coverage for services that are excluded or not fully covered by the statutory health system


Expenditure projections for england 1996 to 2031
Expenditure projections for England, 1996 to 2031 income

1.8% of GDP

Wittenberg et al, Health Statistics Quarterly, winter 2001


‘Those in employment have a duty to ensure, through contributions or taxes, that older people have a decent standard of living’


Where next
Where next? contributions or taxes, that older people have a decent standard of living’

  • Sustainability of public finance

  • Culture of solidarity

    • Interpersonal

    • Intergenerational

  • Rationing

  • EU regulation


Further information
Further information contributions or taxes, that older people have a decent standard of living’

  • [email protected]

  • Or look up publications via

  • www.observatory.dk

  • www.lse.ac.uk/Depts/lsehsc


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