IDEAS home Printed from https://ideas.repec.org/p/zbw/zeswps/042009.html
   My bibliography  Save this paper

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

Author

Listed:
  • Härpfer, Marco
  • Cacace, Mirella
  • Rothgang, Heinz

Abstract

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.

Suggested Citation

  • 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).
    • Handle: RePEc:zbw:zeswps:042009
    as

    Download full text from publisher

    File URL: https://www.econstor.eu/bitstream/10419/39351/1/609490079.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    2. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517, May.
    3. 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.
    4. 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 - Books, The World Bank Group, number 6896, December.
    5. Stefan Bach, 2005. "Mehrwertsteuerbelastung der privaten Haushalte: Dokumentation des Mehrwertsteuer-Moduls des Konsumsteuer-Mikrosimulationsmodells des DIW Berlin auf Grundlage der Einkommens- und Verbrauchsstichprobe," Data Documentation 10, DIW Berlin, German Institute for Economic Research.
    6. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    7. Kakwani, Nanok C, 1977. "Measurement of Tax Progressivity: An International Comparison," Economic Journal, Royal Economic Society, vol. 87(345), pages 71-80, March.
    8. Mr. William C. Hsiao, 2000. "What Should Macroeconomists Know About Health Care Policy: A Primer," IMF Working Papers 2000/136, International Monetary Fund.
    9. Jenkins, Stephen, 1988. "Calculating Income Distribution Indices From Micro-Data," National Tax Journal, National Tax Association;National Tax Journal, vol. 41(1), pages 139-142, March.
    10. Jenkins, Stephen, 1988. "Calculating Income Distribution Indices from Micro-Data," National Tax Journal, National Tax Association, vol. 41(1), pages 139-42, March.
    11. Kühn, Hagen, 1993. "Healthismus: eine Analyse der Präventionspolitik und Gesundheitsförderung in den U.S.A," EconStor Books, ZBW - Leibniz Information Centre for Economics, number 122887, July.
    12. Barr, Nicholas, 1992. "Economic Theory and the Welfare State: A Survey and Interpretation," Journal of Economic Literature, American Economic Association, vol. 30(2), pages 741-803, June.
    13. Aronson, J Richard & Johnson, Paul & Lambert, Peter J, 1994. "Redistributive Effects and Unequal Income Tax Treatment," Economic Journal, Royal Economic Society, vol. 104(423), pages 262-270, March.
    14. Markus Wörz & Reinhard Busse, 2005. "Analysing the impact of health‐care system change in the EU member states – Germany," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 133-149, September.
    15. Anita B. Pfaff & Bernhard Langer & Florian Mamberer & Florian Freund & Axel Olaf Kern & Martin Pfaff, 2003. "Zuzahlungen nach dem GKV-Modernisierungsgesetz (GMG) unter Beruecksichtigung von Haertefallregelungen," Discussion Paper Series 253, Universitaet Augsburg, Institute for Economics.
    16. Adam Wagstaff, 2002. "Reflections on and alternatives to WHO's fairness of financial contribution index," Health Economics, John Wiley & Sons, Ltd., vol. 11(2), pages 103-115, March.
    17. Wagstaff, Adam, 2001. "Measuring equity in health care financing - reflections on (and alternatives to) the World Health Organization's fairness of financing index," Policy Research Working Paper Series 2550, The World Bank.
    18. Gerdtham, Ulf-G. & Johannesson, Magnus, 2000. "Income-related inequality in life-years and quality-adjusted life-years," Journal of Health Economics, Elsevier, vol. 19(6), pages 1007-1026, November.
    19. Barr, Nicholas, 1992. "Economic theory and the welfare state : a survey and interpretation," LSE Research Online Documents on Economics 279, London School of Economics and Political Science, LSE Library.
    20. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    21. Mr. Peter S. Heller, 2007. "What Should Macroeconomists Know about Health Care Policy?," IMF Working Papers 2007/013, International Monetary Fund.
    22. 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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    3. Abu-Zaineh, Mohammad & Mataria, Awad & Luchini, Stéphane & Moatti, Jean-Paul, 2009. "Equity in health care finance in Palestine: The triple effects revealed," Journal of Health Economics, Elsevier, vol. 28(6), pages 1071-1080, December.
    4. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    5. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, vol. 18(3), pages 263-290, June.
    6. Rainer Kotschy & David E. Bloom, 2022. "A Comparative Perspective on Long-Term Care Systems," NBER Working Papers 29951, National Bureau of Economic Research, Inc.
    7. H. Eme Ichoku & William Fonta & Michael Thiede, 2011. "Socioeconomic gradients in self-rated health: a developing country case study of Enugu State, Nigeria," Economic Change and Restructuring, Springer, vol. 44(3), pages 179-202, August.
    8. Mulenga, Arnold & Ataguba, John Ele-Ojo, 2017. "Assessing income redistributive effect of health financing in Zambia," Social Science & Medicine, Elsevier, vol. 189(C), pages 1-10.
    9. Ivonne Honekamp & Daniel Possenriede, 2008. "Redistributive effects in public health care financing," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 405-416, November.
    10. Nübler, Laura & Busse, Reinhard & Siegel, Martin, 2022. "The role of consumer choice in out-of-pocket spending on health: A mixed-methods approach," EconStor Preprints 260395, ZBW - Leibniz Information Centre for Economics.
    11. Jordi Arcarons & Samuel Calonge, 2015. "Inference tests for tax progressivity and income redistribution: the Suits approach," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 13(2), pages 207-223, June.
    12. Costa-Font, Joan & Hernández-Quevedo, Cristina, 2012. "Measuring inequalities in health: What do we know? What do we need to know?," Health Policy, Elsevier, vol. 106(2), pages 195-206.
    13. Gabriel M. Leung & Keith Y. K. Tin & Owen O'Donnell, 2009. "Redistribution or horizontal equity in Hong Kong's mixed public–private health system: a policy conundrum," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 37-54, January.
    14. 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.
    15. Hullegie, P.G.J., 2012. "Essays on health and labor economics," Other publications TiSEM dcc68fc9-7af1-4ba9-8f90-6, Tilburg University, School of Economics and Management.
    16. Gerdtham, Ulf-G. & Sundberg, Gun, 1996. "Redistributive Effects of the Swedish Health Care Financing System," SSE/EFI Working Paper Series in Economics and Finance 115, Stockholm School of Economics.
    17. Sinn, Hans-Werner, 1997. "The selection principle and market failure in systems competition," Journal of Public Economics, Elsevier, vol. 66(2), pages 247-274, November.
    18. Qing Li & Alain A. Cohen & Linda P. Fried, 2017. "A novel health metric based on biomarkers," Cahiers de recherche 17-08, Departement d'économique de l'École de gestion à l'Université de Sherbrooke.
    19. Thierry Debrand & Christine Sorasith, 2010. "Bouclier sanitaire : choisir entre égalité et équité ? Une analyse à partir du modèle ARAMMIS," Working Papers DT32, IRDES institut for research and information in health economics, revised Jun 2010.
    20. Marcel Bilger & Eliza J. Kruger & Eric A. Finkelstein, 2017. "Measuring Socioeconomic Inequality in Obesity: Looking Beyond the Obesity Threshold," Health Economics, John Wiley & Sons, Ltd., vol. 26(8), pages 1052-1066, August.

    More about this item

    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:zbw:zeswps:042009. See general information about how to correct material in RePEc.

    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 bibliographic 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.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ZBW - Leibniz Information Centre for Economics (email available below). General contact details of provider: https://edirc.repec.org/data/zesbrde.html .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.