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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?. - PowerPoint PPT Presentation
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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?
Proportion of tax and SHI as % THE in western Europe
0
20
40
60
80
100
0 20 40 60 80 100
Percentage of total health expenditure from taxationPer
cen
tag
e o
f to
tal
hea
lth
exp
end
itu
re f
rom
so
cial
hea
lth
in
sura
nce
UK
FIN
D
F
S
NL
GRE
IRL
DK
CH
I
B
L
NOREP
Contribution of taxation to social health insurance fund incomeAustria:
– 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?
Upper income ceiling
Lower income threshold
Earnings
% c
ontr
ibut
ion
Top income tax rate
Lower income tax rate
How fair is tax?
Middle income tax rate
Income
% c
ontr
ibut
ion
Changes to social health insurance Universal coverage Wider revenue base Greater government control Choice and competition
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
Netherlands (1987) Germany (1996) Switzerland (1911) Belgium (1945)
Out-of-pocket payments as % of total health expenditure
Country OOP % THE
Year 1998 unless stated
Netherlands 5.9 Luxembourg 7.4 1997 France 10.3 U.K. 10.8 Germany 11.9 1997 Ireland 12.3 1995 Iceland 15.2 1999 Denmark 16.6 Austria 18.3 Finland 19.8 Switzerland 29.9 Portugal 44.6 1995
OECD Health Data 2000
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…
“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
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
148%222%
84%154%
249%
0% 50% 100% 150% 200% 250% 300%
Growth
Unit costs rise 1% faster paProp'n single people living with others halvesAge-specific dependency decreases 1% paAge-specific dependency grows 1% paBase case
Wittenberg et al, Health Statistics Quarterly, winter 2001
1.8% of GDP
‘Those in employment have a duty to ensure, through contributions or taxes, that older people have a decent standard of living’
0
10
20
30
40
50
60
70
Denmark France Spain UK EC12
Agree strongly Agree slightly Disagree Don't know
Where next?
Sustainability of public finance Culture of solidarity
– Interpersonal– Intergenerational
Rationing EU regulation
Further information
Or look up publications via www.observatory.dk www.lse.ac.uk/Depts/lsehsc
