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And fairness for all? Wie gerecht ist die Finanzierung im deutschen Gesundheitssystem? Eine Berechnung des Kakwani-Index auf Basis der EVS


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  • Härpfer, Marco
  • Cacace, Mirella
  • Rothgang, Heinz
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    Unser Beitrag thematisiert soziale Gerechtigkeit in der Finanzierung des deutschen Gesundheitssystems. Obgleich in öffentlichen Debatten häufig mit sozialer Gerechtigkeit argumentiert wird, fehlt ein entsprechendes Konzept und demzufolge auch die empirische Fundierung. Wir greifen dieses Defizit auf indem wir (1) einen theoretischen Referenzrahmen ableiten und (2) die empirischen Ergebnisse zu sozialer Gerechtigkeit im Status Quo des deutschen Gesundheitssystems aktualisieren. Als theoretischen Referenzrahmen wählen wir das WHO Konzept zur fairen Finanzierung in Gesundheitssystemen. Nach einer Zusammenfassung der Kritik an der WHO Studie benennen wir als Postulate: (1) keine risikogebundenen Prämien (2) Haushalte mit gleichem Einkommen sollen gleiche Prämien bezahlen (horizontal justice) (3) höhere Einkommen führen zu entsprechend höheren Prämien (vertical justice). Zur Messung fairer Finanzierung berechnen wir die Gesamt- und Teilwerte des Kakwani-Index auf Basis aktueller Daten der Einkommens- und Verbrauchsstichprobe 2003 (EVS 2003). Im Vergleich zeigen unsere Ergebnisse für den Gesamtindex, dass die Finanzierung der Gesundheitsausgaben innerhalb der vergangenen 15 Jahre geringfügig weniger regressiv geworden ist (von -0.045 auf -0.041). Bei einer differenzierten Betrachtung der einzelnen Finanzierungskomponenten zeigen sich Verschiebungen. Wir schließen unsere Betrachtung mit einem methodischen Hinweis zur Anwendung des Kakwani-Index für das deutsche Gesundheitssystem. -- This contribution deals with social justice in healthcare financing in Germany. It starts from the observation that social justice - although often referred to in the public debate - is neither explicitly conceptualized nor empirically measured. Our paper provides (1) a theoretical framework and (2) a timely empirical basis, reflecting fairness in financing in the status quo of the German healthcare system. With regards to the first point, we recur to the normative concept underpinning the WHO Report 2000. After summing up the critique the WHO study provoked, we extract that (1) healthcare premiums should not be risk-dependent, (2) all households with equal disposable income should make equal contributions (horizontal justice), and (3) higher income should lead to higher contributions (vertical justice). For the measurement of fair financing in the German healthcare system, we calculate the Kakwani-Index (overall index and partial indices) based on most recent available empirical data set of the Sample Survey of Income and Expenditure 2003 (EVS 2003). Our results for the overall Kakwani-Index show that healthcare financing in Germany has become slightly less regressive (from -0.045 to-0.041) within the past 15 years. Furthermore, we find some interesting changes in the partial indices. Finally, we point at the limits the Kakwani-Index imposes on the measurement of fair financing in the German healthcare system from a methodological perspective.

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    Paper provided by University of Bremen, Centre for Social Policy Research (ZeS) in its series Working papers of the ZeS with number 04/2009.

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    Date of creation: 2009
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    Handle: RePEc:zbw:zeswps:042009

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