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EQUITY IN THE DELIVERY OF HEALTH-CARE - SOME INTERNATIONAL COMPARISONS

JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 389-411页

作者： VANDOORSLAER, E WAGSTAFF, A UNIV SUSSEX SCH SOCIAL SCIARTS BLDGBRIGHTON BN1 9QNENGLAND ERASMUS UNIV 3000 DR ROTTERDAMNETHERLANDS

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 that 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.

关键词：文化交叉比较卫生保健提供/经济学卫生保健提供/标准卫生保健提供/统计学和数值数据欧洲卫生经费支出/统计学和数值数据卫生服务易得程度/经济学卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据卫生服务研究收入/分类保险健康/经济学保险健康/标准保险健康/统计学和数值数据国际性模型经济计量学国家卫生规划/经济学国家卫生规划/标准国家卫生规划/统计学和数值数据回归分析社会正义/经济学社会经济因素公费医疗/经济学公费医疗/标准公费医疗/统计学和数值数据美国

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Private payers of health care in Brazil: Characteristics, costs and coverage

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HEALTH POLICY AND PLANNING 1995年第4期10卷 362-375页

作者： Lewis, MA Medici, AC INST ECON SECTOR PUBL SAO PAULOBRAZIL

The private sector is the predominant provider of health care in Brazil, particularly for inpatient services, and financing is a mix of public (through a prospective reimbursement system) and private. Roughly a quarter of the population has private insurance coverage, reflecting rapid growth in the past decade fuel-led by the crisis in the public reimbursement system and the perceived deterioration of publicly provided care. Four major forms of insurance exist: (1) prepaid group practice;(2) medical cooperatives, physician owned and operated preferred provider organizations;(3) company health plans where employers ensure employee access to services under various types of arrangements from direct provision to purchasing of private services;and (4) health indemnity insurance. Each type of plan includes a wide variety of subplans from basic individual/family coverage to comprehensive executive coverage. The paper discusses the characteristics, costs and utilization patterns of all types of privately financed care, as well as the major problems associated with private financing: the limited package of benefits and low payout ceilings, inadequate consumer information and virtually no regulation.

关键词：巴西数据收集卫生保健提供/经济学发展中国家企业家能力筹资组织卫生保健费用卫生服务研究保险健康/分类保险健康/统计学和数值数据保险健康/发展趋势国家卫生规划/经济学国家卫生规划/统计学和数值数据私营部门/经济学私营部门/统计学和数值数据私营部门/发展趋势

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Micro-level analysis of distributional changes in health care financing in Finland

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Journal of Health Services Research and Policy 1998年第1期3卷 23-30页

作者： Klavus, J. Hakkinen, U. STAKES Nat. R and D Centre Welfare Health Health Services Research Unit FIN-00531 Helsinki PO Box 220 Finland

Objectives: In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. Method: The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). Results: In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. Conclusions: It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

关键词：费用分担/统计学和数值数据费用分担/发展趋势筹资政府/统计学和数值数据筹资政府/发展趋势芬兰卫生保健改革卫生经费支出/统计学和数值数据卫生经费支出/发展趋势卫生服务研究收入/统计学和数值数据收入/发展趋势所得税膨胀通货国家卫生规划/经济学国家卫生规划/统计学和数值数据贫困/统计学和数值数据公营部门人类

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EQUITY IN THE FINANCE OF HEALTH-CARE - SOME INTERNATIONAL COMPARISONS

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 361-387页

作者： WAGSTAFF, A VANDOORSLAER, E ERASMUS UNIV 3000 DR ROTTERDAMNETHERLANDS

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.

关键词：文化交叉比较卫生保健提供/经济学卫生保健提供/统计学和数值数据欧洲筹资政府/经济学筹资政府/方法筹资政府/统计学和数值数据卫生经费支出/统计学和数值数据卫生服务研究保险健康/经济学国际性模型经济计量学国家卫生规划/经济学国家卫生规划/组织和管理国家卫生规划/统计学和数值数据回归分析公费医疗/经济学公费医疗/组织和管理公费医疗/统计学和数值数据税款/经济学美国

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