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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

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.

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  • 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
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    1. Gerdtham, Ulf-G. & Johannesson, Magnus, 1999. "Income-Related Inequality in Life-Years and Quality-Adjusted Life-Years," SSE/EFI Working Paper Series in Economics and Finance 334, Stockholm School of Economics.
    2. 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.
    3. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, Oxford University Press, pages 629-649.
    4. 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, pages 251-277.
    5. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517.
    6. Peter S. Heller, 2007. "What Should Macroeconomists Know about Health Care Policy?," IMF Working Papers 07/13, International Monetary Fund.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. Kakwani, Nanok C, 1977. "Measurement of Tax Progressivity: An International Comparison," Economic Journal, Royal Economic Society, vol. 87(345), pages 71-80, March.
    12. Jenkins, Stephen, 1988. "Calculating Income Distribution Indices From Micro-Data," National Tax Journal, National Tax Association, pages 139-142.
    13. Jenkins, Stephen, 1988. "Calculating Income Distribution Indices from Micro-Data," National Tax Journal, National Tax Association, vol. 41(1), pages 139-42, March.
    14. Barr, Nicholas, 1992. "Economic Theory and the Welfare State: A Survey and Interpretation," Journal of Economic Literature, American Economic Association, pages 741-803.
    15. William C. Hsiao, 2000. "What Should Macroeconomists Know About Health Care Policy; A Primer," IMF Working Papers 00/136, International Monetary Fund.
    16. 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.
    17. 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.
    18. 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.
    19. 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.
    20. Gerdtham, Ulf-G. & Johannesson, Magnus, 2000. "Income-related inequality in life-years and quality-adjusted life-years," Journal of Health Economics, Elsevier, pages 1007-1026.
    21. 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.
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