Is tax funding of health care more likely to be regressive than systems based on social insurance in low and middle-income countries?

  • Aurelio Mejía Facultad de Ciencias Económicas, Universidad de Antioquia

Resumen

Is tax funding of health care more likely to be regressive than systems based on social insurance in low and middle-income countries?

Abstract: One of the main functions of health care systems is to collect enough revenue to finance health expenditures. This revenue can be obtained through different sources (taxes, social insurance contributions, out-of-pocket payments, donations), each of which has different implications in terms of equity. The equity implications of the different forms of revenue collection are an important component of health systems performance evaluation. The international evidence suggests that tax funded systems seem to be a more progressive health care financing mechanism than systems based on social insurance in low- and middle-income countries. However, progressivity results are sensitive to the choice of ability to pay measures and, therefore, policy makers must be aware of this fact when interpreting results of studies on health care financing.

Key words: health systems financing, progressivity, equity.

JEL classification: I11, I14

 

¿Es posible que la financiación tributaria de la salud sea más regresiva que los sistemas basados en el aseguramiento social en países de ingreso bajo y medio? 

Resumen: Una de las funciones principales de los sistemas de salud es recaudar recursos suficientes para financiar el gasto en salud. Estos recursos provienen de diversas fuentes (impuestos, donaciones, contribuciones a la seguridad social, gasto de bolsillo), las cuales pueden tener diferentes implicaciones en términos de equidad, componente clave en la evaluación del desempeño de los sistemas sanitarios. La evidencia internacional sugiere que en los países de ingresos bajos y medios los sistemas que recaudan los ingresos fundamentalmente vía impuestos tienden a ser más progresivos que los sistemas basados en aseguramiento. Sin embargo, este resultado depende de la medida de capacidad de pago elegida y, por lo tanto, los responsables de tomar decisiones deben tener en cuenta este hecho al interpretar los resultados de los estudios sobre la progresividad en el financiamiento de los sistemas de salud.

Palabras clave: financiamiento de sistemas de salud, progresividad, equidad.

Clasificación JEL: I11, I14

 

Est-il possible que le financement des systèmes de santé par des impôts soit plus régressif que les systèmes fondés sur l'assurance sociale dans les pays à revenu faible et moyen?

Résumé: L'une des principales fonctions des systèmes de santé est celui de collecter des fonds suffisamment pour financer les dépenses de santé. Ces fonds ont une diversité des sources (taxes, contributions de sécurité sociale, dépenses de poche, donations), lesquels peuvent avoir des implications en termes d'équité, ce qui constitue un élément clé dans l'évaluation de la performance des systèmes de santé. L'expérience internationale montre que les pays à faible revenu et les pays à revenu moyens qui ont des systèmes de santé financés par les impôts, sont plus progressistes par rapport aux systèmes de santé financés par l'assurance sociale. Toutefois, ce résultat dépend de la mesure choisie entant que capacité de paiement. Par conséquent, les responsables de la politique de santé doivent avoir très présent ce fait lors de leur interprétation des résultats des études concernant la progressivité dans le financement des systèmes de santé.

Mots-clés: financement des systèmes de santé, progressivité, équité.

Classification JEL: I11, I14

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Citas

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Publicado
2013-07-09
Cómo citar
Mejía, A. (2013). Is tax funding of health care more likely to be regressive than systems based on social insurance in low and middle-income countries?. Lecturas De Economía, (78), 229-239. https://doi.org/10.17533/udea.le.n0a15770
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