The progressivity of health care revenue financing in 29 countries: A comparison

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-06-22 DOI:10.1016/j.healthpol.2025.105381

Andres Võrk , Peter Pažitný , Ruth Waitzberg , Sara Allin , Daiga Behmane , Nicolas Bouckaert , Damien Bricard , Lucie Bryndová , Antoniya Dimova , Fidelia Cascini , Péter Gaál , Katharina Habimana , Marios Kantaris , Ewa Kocot , Madelon Kroneman , Liubovė Murauskienė , Zeynep Or , Carlo de Pietro , Ingrid S. Saunes , Steve Thomas , Thomas Rice

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引用次数: 0

Abstract

Background

This study assesses progressivity in public and private health care revenue collection among 29 high-income countries by combining the results of two previous articles comprising this special section of Health Policy. In those studies, we developed qualitatively based scores regarding revenue collection policies for three public revenue sources (income taxes, social insurance contributions, consumption taxes) and two private revenue sources (voluntary health insurance, out-of-pocket payments).

Objective

The current study sums these scores, weighted by the shares of each revenue source in each country, to calculate an overall progressivity score for each country.

Methods

We derived weights for each revenue source using publicly available OECD and Eurostat macrolevel data on the structure of health care financing and government revenues.

Results

France was the country that had the most progressive system, and Latvia, Hungary, and Bulgaria, the least progressive.

Conclusions

Countries relying more on out-of-pocket payments tend to be more regressive overall, suggesting that, from an equity perspective, their role should remain limited. Tax-based systems do not inherently ensure progressivity, especially when relying heavily on regressive consumption taxes. While wealthier countries and those with less income inequality tend to be more progressive, in contrast, Switzerland and Germany both scored among the more regressive countries. Our study shows that policy matters in promoting progressivity in health system revenue collection. Both public and private sources can be regressive if nothing is done. Yet, there are policy instruments that can mitigate regressivity, and even private sources of funds can be made less regressive.

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29个国家卫生保健收入筹资的累进性：比较

本研究通过结合构成《卫生政策》这一特殊章节的前两篇文章的结果，评估了29个高收入国家的公共和私人医疗保健收入的累进性。在这些研究中，我们对三个公共收入来源（所得税、社会保险缴款、消费税）和两个私人收入来源（自愿医疗保险、自付费用）的税收政策进行了定性评分。当前的研究将这些分数相加，按每个国家每个收入来源的份额加权，以计算每个国家的总体累进性分数。方法：我们使用公开的经合组织和欧盟统计局关于卫生保健融资结构和政府收入的宏观数据，得出每个收入来源的权重。结果：法国的教育制度最进步，拉脱维亚、匈牙利和保加利亚的教育制度最不进步。更多依赖自掏腰包的国家总体上倾向于更累退，这表明，从公平的角度来看，他们的作用应该是有限的。以税收为基础的制度并不能从本质上确保累进性，尤其是在严重依赖累退消费税的情况下。虽然富裕国家和收入不平等程度较低的国家往往更进步，但相比之下，瑞士和德国都属于倒退程度较高的国家。我们的研究表明，政策在促进卫生系统税收累进性方面很重要。如果不采取任何措施，公共和私人资源都可能造成倒退。然而，有一些政策工具可以减轻累退性，甚至私人资金来源也可以减少累退性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.