Equity in healthcare financing

A review of evidence

Dados Bibliográficos

ID21467078
AutoresEmilia Luyten (UCLouvain), Sandy Tubeuf (0000-0001-9001-1157, UCLouvain, autor correspondente)
Ano2025
Volume152
Páginas105218
Data de publicação2025-02-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoHealth Policy (JOURNAL)
Identificadores do periódicoISSN: 0168-8510 • E-ISSN: 1872-6054
EditoraElsevier BV (PUBLISHER)
DOI10.1016/j.healthpol.2024.105218
PMID39740647
OpenAlexW4404811634
IdiomaEN
Citações recebidas2
Referências citadas46

The design of health financing impacts income redistribution within the population. • Health financing with progressive taxation can reduce post-taxes income inequality. • Tax-based systems are more redistributive than social and private health systems. • Recent studies on the redistribution of health financing sources are limited. This review summarises empirical studies on the progressivity and redistributive effects of healthcare financing mechanisms. The evidence varies significantly across countries and financing sources. Tax-based systems exhibit high progressivity, as direct taxes contribute to a favourable redistribution toward low-income households, often offsetting the regressive nature of indirect taxes. Social insurance systems are found to be progressive but may be regressive in practice due to contribution ceilings and exemptions for high-income earners. This creates disparities where high-income taxpayers benefit from social protection while contributing less proportionally to their total income, limiting the overall positive redistributive effect on income inequalities. Most health systems with co-payments use flat rates rather than income-based rates, disproportionately affecting lower-income individuals and potentially leading to catastrophic expenses. This review highlights a lack of recent research on healthcare financing in high-income countries, while recent studies in low- and middle-income countries align with commitment to deliver universal health coverage. Continuous analysis of the redistributive effects of the health system is essential to ensure that health financing systems not only fund healthcare effectively but also contribute to broader social equity goals

Business · Economic growth · Economics · Health care · Health equity · Political science · Global Health Care Issues · Healthcare Policy and Management · Healthcare Systems and Reforms · Finance