IDEAS home Printed from https://ideas.repec.org/p/ven/wpaper/201616.html
   My bibliography  Save this paper

Do healthcare tax credits help poor healthy individuals on low incomes?

Author

Listed:
  • Cinzia Di Novi

    () (University of Pavia, Department of Economics and Management; Health, Econometrics and Data Group, University of York; LCSR, National Research University Higher School of Economics, Russian Federation.)

  • Anna Marenzi

    () (Ca' Foscari University of Venice, Department of Economics)

  • Dino Rizzi

    () (Ca' Foscari University of Venice, Department of Economics)

Abstract

In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditures. Tax credits produce two effects on taxpayers’ disposable income. On the one hand, they benefit taxpayers at all income levels by reducing their net tax liability; on the other hand, they modify the price of out-of-pocket expenditure and, to the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These two effects influence, in turn, income redistribution and may affect taxpayers’ health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated; however, little is known about the ability of tax credits to ensure a more equitable distribution of healthcare expenditure and, consequently, to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on health-related inequality with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model which reproduces the personal income tax and incorporates taxpayers’ behavioural responses to changes in tax credit rate. Our results suggest that a healthcare tax credit design that does not rely on income, like the one implemented in the Italian personal income tax, is not effective in improving equity in health and tends to favour the richest part of the population.

Suggested Citation

  • Cinzia Di Novi & Anna Marenzi & Dino Rizzi, 2016. "Do healthcare tax credits help poor healthy individuals on low incomes?," Working Papers 2016:16, Department of Economics, University of Venice "Ca' Foscari".
  • Handle: RePEc:ven:wpaper:2016:16
    as

    Download full text from publisher

    File URL: http://www.unive.it/pag/fileadmin/user_upload/dipartimenti/economia/doc/Pubblicazioni_scientifiche/working_papers/2016/WP_DSE_dinovi_marenzi_rizzi_16_16.pdf
    File Function: First version, anno
    Download Restriction: no

    Other versions of this item:

    References listed on IDEAS

    as
    1. Esmeralda Ramalho & Joaquim Ramalho & Pedro Henriques, 2010. "Fractional regression models for second stage DEA efficiency analyses," Journal of Productivity Analysis, Springer, vol. 34(3), pages 239-255, December.
    2. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
    3. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    4. Michael Baker & Mark Stabile & Catherine Deri, 2004. "What Do Self-Reported, Objective, Measures of Health Measure?," Journal of Human Resources, University of Wisconsin Press, vol. 39(4).
    5. Leonard E. Burman & Christopher Geissler & Eric J. Toder, 2008. "How Big Are Total Individual Income Tax Expenditures, and Who Benefits from Them?," American Economic Review, American Economic Association, vol. 98(2), pages 79-83, May.
    6. Dixon, Huw & Siciliani, Luigi, 2009. "Waiting-time targets in the healthcare sector: How long are we waiting?," Journal of Health Economics, Elsevier, vol. 28(6), pages 1081-1098, December.
    7. Wilkinson, Richard G & Pickett, Kate E., 2006. "Income inequality and population health: A review and explanation of the evidence," Social Science & Medicine, Elsevier, vol. 62(7), pages 1768-1784, April.
    8. Johnston, David W. & Propper, Carol & Shields, Michael A., 2009. "Comparing subjective and objective measures of health: Evidence from hypertension for the income/health gradient," Journal of Health Economics, Elsevier, vol. 28(3), pages 540-552, May.
    9. Paul Contoyannis & Andrew M. Jones & Nigel Rice, 2004. "The dynamics of health in the British Household Panel Survey," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 473-503.
    10. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications, The World Bank, number 6896, 06-2020.
    11. James M. Poterba, 2011. "Economic Analysis of Tax Expenditures," NBER Books, National Bureau of Economic Research, Inc, number pote08-2, June.
    12. Balia, Silvia & Jones, Andrew M., 2008. "Mortality, lifestyle and socio-economic status," Journal of Health Economics, Elsevier, vol. 27(1), pages 1-26, January.
    13. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    14. Besley, Timothy & Hall, John & Preston, Ian, 1999. "The demand for private health insurance: do waiting lists matter?," Journal of Public Economics, Elsevier, vol. 72(2), pages 155-181, May.
    15. Contoyannis, Paul & Jones, Andrew M., 2004. "Socio-economic status, health and lifestyle," Journal of Health Economics, Elsevier, vol. 23(5), pages 965-995, September.
    16. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    17. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375, March.
    18. Getzen, Thomas E., 2000. "Health care is an individual necessity and a national luxury: applying multilevel decision models to the analysis of health care expenditures," Journal of Health Economics, Elsevier, vol. 19(2), pages 259-270, March.
    19. Cinzia Di Novi, 2010. "The influence of traffic‐related pollution on individuals' life‐style: results from the BRFSS," Health Economics, John Wiley & Sons, Ltd., vol. 19(11), pages 1318-1344, November.
    20. Adam Wagstaff & Eddy van Doorslaer, 2001. "What Makes the Personal Income Tax Progressive? A Comparative Analysis for Fifteen OECD Countries," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 8(3), pages 299-316, May.
    21. repec:mpr:mprres:5058 is not listed on IDEAS
    22. Costa-Font, Joan & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2014. "Income inequalities in unhealthy life styles in England and Spain," Economics & Human Biology, Elsevier, vol. 13(C), pages 66-75.
    23. Gian Paolo Barbetta & Simone Pellegrino & Gilberto Turati, 2018. "What Explains the Redistribution Achieved by the Italian Personal Income Tax? Evidence from Administrative Data," Public Finance Review, , vol. 46(1), pages 7-28, January.
    24. Andrea Albarea & Michele Bernasconi & Cinzia Di Novi & Anna Marenzi & Dino Rizzi & Francesca Zantomio, 2015. "Accounting for Tax Evasion Profiles and Tax Expenditures in Microsimulation Modelling. The BETAMOD Model for Personal Income Taxes in Italy," International Journal of Microsimulation, International Microsimulation Association, vol. 8(3), pages 99-136.
    25. Michael Smart & Mark Stabile, 2005. "Tax credits, insurance, and the use of medical care," Canadian Journal of Economics, Canadian Economics Association, vol. 38(2), pages 345-365, May.
    26. Carlotta Balestra & Joyce Sultan, 2013. "Home Sweet Home: The Determinants of Residential Satisfaction and its Relation with Well-being," OECD Statistics Working Papers 2013/5, OECD Publishing.
    27. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 31(3), pages 129-137.
    28. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health‐care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202, September.
    29. Jennifer L Kohn, 2012. "What is Health? A Multiple Correspondence Health Index," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 38(2), pages 223-250.
    30. Louis Kaplow, 1991. "The Income Tax as Insurance: The Casualty Loss and Medical Expense Deductions and the Exclusion of the Medical Insurance Premiums," NBER Working Papers 3723, National Bureau of Economic Research, Inc.
    31. de Belvis, Antonio Giulio & Ferrè, Francesca & Specchia, Maria Lucia & Valerio, Luca & Fattore, Giovanni & Ricciardi, Walter, 2012. "The financial crisis in Italy: Implications for the healthcare sector," Health Policy, Elsevier, vol. 106(1), pages 10-16.
    32. Poterba, James M., 2011. "Introduction: Economic Analysis of Tax Expenditures," National Tax Journal, National Tax Association;National Tax Journal, vol. 64(2), pages 451-457, June.
    33. Chiara Canta & Massimiliano Piacenza & Turati Gilberto, 2005. "Riforme del Servizio Sanitario Nazionale e dinamica dell’efficienza ospedaliera in Piemonte," CERIS Working Paper 200515, Institute for Economic Research on Firms and Growth - Moncalieri (TO) ITALY -NOW- Research Institute on Sustainable Economic Growth - Moncalieri (TO) ITALY.
    34. Mackenbach, Johan P., 2012. "The persistence of health inequalities in modern welfare states: The explanation of a paradox," Social Science & Medicine, Elsevier, vol. 75(4), pages 761-769.
    35. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    36. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    37. Burman, Leonard E., 2003. "Is the Tax Expenditure Concept Still Relevant?," National Tax Journal, National Tax Association;National Tax Journal, vol. 56(3), pages 613-627, September.
    38. Jakobsson, Ulf, 1976. "On the measurement of the degree of progression," Journal of Public Economics, Elsevier, vol. 5(1-2), pages 161-168.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Christian Bührer & Stefan Fetzer & Christian Hagist, 2018. "Adverse Selection in the German Health Insurance System – The Case of Civil Servants," WHU Working Paper Series - Economics Group 18-06, WHU - Otto Beisheim School of Management.

    More about this item

    Keywords

    personal income tax; health-related tax credit; health inequality;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • H24 - Public Economics - - Taxation, Subsidies, and Revenue - - - Personal Income and Other Nonbusiness Taxes and Subsidies

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ven:wpaper:2016:16. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Geraldine Ludbrook). General contact details of provider: http://edirc.repec.org/data/dsvenit.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.