Funding health care current options and future direction
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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 current options and future direction

Funding health care: current options and future direction

Anna Dixon

Research Officer


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?

Upper income ceiling

% contribution

Lower income threshold

Earnings


How fair is tax

Middle income tax rate

How fair is tax?

Top income tax rate

% contribution

Lower income tax rate

Income


Changes to social health insurance

Changes to social health insurance

  • Universal coverage

  • Wider revenue base

  • Greater government control

  • Choice and competition


Extension of coverage germany

Extension of coverage, Germany

  • 1883 – 10% pop covered

  • 1901 – white collar from transport and commercial

  • 1914 – domestic servants, agricultural and forestry

  • 1972 – farmers


Insurance competition

Insurance Competition

  • Netherlands (1987)

  • Germany (1996)

  • Switzerland (1911)

  • Belgium (1945)


Out of pocket payments as of total health expenditure

Out-of-pocket payments as % of total health expenditure

OECD Health Data 2000


Differing impacts of user charges

Differing impacts of user charges

  • 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…

  • “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

  • 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

1.8% of GDP

Wittenberg et al, Health Statistics Quarterly, winter 2001


Funding health care current options and future direction

‘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?

  • Sustainability of public finance

  • Culture of solidarity

    • Interpersonal

    • Intergenerational

  • Rationing

  • EU regulation


Further information

Further information

  • [email protected]

  • Or look up publications via

  • www.observatory.dk

  • www.lse.ac.uk/Depts/lsehsc


  • Login