Inkomensbeleid in het ziektekostenstelsel

Tijdens de paarse kabinetten is de inkomenssolidariteit in het ziektekostenstelsel de facto toegenomen. In de nieuwe plannen worden de ziektekosten minder gebruikt als instrument in het inkomensbeleid

Equity in the finance of health care: Some international comparisons

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues

The role of the sickness funds in the Belgian health care market

This article reviews some of the salient features of the Belgian health care finance and delivery system. Special attention is paid to the role played by the third-party payers, i.e. the Health Insurance Associations (HIAs) in administering the compulsory national health insurance program. It is shown how, despite extensive government regulation, the markets for GP, specialist and hospital services exhibit fierce competition of the non-price variety. Next, the paper considers the three problems perceived to be the most pressing ones at present: (i) the problem of raising sufficient revenues to cover the public share of health expenditures; (ii) the (related) cost containment problem; and (iii) the problem of ensuring efficiency through appropriate incentive mechanisms. Finally, two recently proposed options for reform are discussed and complemented with a third proposal based on the ideas of regulated competition. It is concluded that strengthening the role of the third-party payers remains crucial in any attempt to reshape the system to make it efficient and affordable while keeping it equitable

Equity in the delivery of health care: some international comparisons

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but that there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same

A welfare economics foundation for health inequality measurement

The empirical literature on the measurement of health inequalities is vast and rapidly expanding. To date, however, no foundation in welfare economics exists for the proposed measures of health inequality. This paper provides such a foundation for commonly used measures like the health concentration index, the Gini index, and the extended concentration index. Our results indicate that these measures require assumptions that appear restrictive. One way forward may be the development of multi-dimensional extensions

“A built bed is a filled bed?” An empirical re-examination

This article provides an empirical re-examination of the relationship between regional hospital bed supply and the utilization of hospital care. It tests the hypothesis that the divergence of findings between studies based on micro-data (at the individual level) and those based on macro-data (at the regional level) is due to aggregation and specification bias. The main conclusion is that neither source of bias can account for the observed differences. Some other possible explanations are put forward. Regardless of the level of aggregation, a positive effect is found of bed supply on length of hospital stay but not on admission rates. This may be the result of major changes which have taken place in the financing of hospital services in the Netherlands during the last decade

Langer leren om langer te leven

Een van de meest opzienbarende en robuuste bevindingen in de sociale wetenschappen is de sterke samenhang tussen opleiding en gezondheid en sterfte. Deze relatie vloeit deels voort uit een causaal effect van opleiding op overleving

Horizontal equity in the delivery of health care

This paper offers a critical appraisal of the various methods used to date to investigate inequity in the delivery of health care. It concludes that none of the methods used to date is particularly well equipped to provide unbiassed estimates of the extent of inequity. It also concludes that Le Grand's (1978) approach is likely to point towards inequity favouring the rich even when none exists. The paper offers an alternative approach, which builds on the approaches to date but seeks to overcome their deficiencies

Long Run Returns to Education: Does Schooling Lead to an Extended Old Age?

While there is no doubt that health is strongly correlated with education, whether schooling exerts a causal impact on health is not yet firmly established. We exploit Dutch compulsory schooling laws in a Regression Discontinuity Design applied to linked data from health surveys, tax files and the mortality register to estimate the causal effect of education on mortality. The reform provides a powerful instrument, significantly raising years of schooling, which, in turn, has a large and significant effect on mortality even in old age. An extra year of schooling is estimated to reduce the probability of dying between ages of 81 and 88 by 2-3 percentage points relative to a baseline of 50 percent. High school graduation is estimated to reduce the probability of dying between the ages of 81 and 88 by a remarkable 17-26 percentage points but this does not appear to be due to any sheepskin effects of finishing high school on mortality beyond that predicted lin early by additional years of schooling