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The Distributional Impact of Health Financing in Europe: A Review


  • Diana De Graeve
  • Tom Van Ourti


This article summarises, extends and updates previous empirical work on the distributional implications of alternative health care financing arrangements in a selection of European countries and the US. On the one hand, total health care payments are almost proportional to ability to pay in most countries. This is predominantly driven by a high reliance on public financing. On the other hand, private payments - out-of-pocket payments as well as private insurance premiums - are highly regressive. More extended reliance on private financing may therefore endanger the equitable nature of financing systems. In addition, private payments put a heavy burden on unfortunate households. Copyright Blackwell Publishing Ltd 2003.

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  • Diana De Graeve & Tom Van Ourti, 2003. "The Distributional Impact of Health Financing in Europe: A Review," The World Economy, Wiley Blackwell, vol. 26(10), pages 1459-1479, November.
  • Handle: RePEc:bla:worlde:v:26:y:2003:i:10:p:1459-1479

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    References listed on IDEAS

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    Cited by:

    1. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," CORE Discussion Papers 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    2. Härpfer, Marco & Cacace, Mirella & Rothgang, Heinz, 2009. "And fairness for all? Wie gerecht ist die Finanzierung im deutschen Gesundheitssystem? Eine Berechnung des Kakwani-Index auf Basis der EVS," Working papers of the ZeS 04/2009, University of Bremen, Centre for Social Policy Research (ZeS).
    3. Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 25-39.
    4. Panagiotis Petrou, 2015. "An Interrupted Time-Series Analysis to Assess Impact of Introduction of Co-Payment on Emergency Room Visits in Cyprus," Applied Health Economics and Health Policy, Springer, vol. 13(5), pages 515-523, October.
    5. Amedeo Spadaro & Lucia Mangiavacchi & Ignacio Moral-Arce & Marta Adiego-Estella & Angela Blanco-Moreno, 2013. "Evaluating the redistributive impact of public health expenditure using an insurance value approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 775-787, October.
    6. Krůtilová, Veronika & Yaya, Sanni, 2012. "Unexpected impact of changes in out-of-pocket payments for health care on Czech household budgets," Health Policy, Elsevier, vol. 107(2), pages 276-288.
    7. Schmid, Achim & Siemsen, Pascal & Götze, Ralf, 2015. "Keeping an eye on IRIS: Risk and income solidarity in OECD healthcare systems," TranState Working Papers 191, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    8. Kronenberg, Christoph & Barros, Pedro Pita, 2014. "Catastrophic healthcare expenditure – Drivers and protection: The Portuguese case," Health Policy, Elsevier, vol. 115(1), pages 44-51.
    9. Jinkook Lee, 2010. "Data sets on pensions and health: Data collection and sharing for policy design," PGDA Working Papers 5910, Program on the Global Demography of Aging.
    10. Rothgang, Heinz & Cacace, Mirella, 2005. "Fair financing in Germany's public health insurance: income-related contributions or flat premiums," TranState Working Papers 26, University of Bremen, Collaborative Research Center 597: Transformations of the State.

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