Klavus J, Häkkinen U
National R&D Centre for Welfare & Health, Helsinki, Finland.
J Health Serv Res Policy. 1998 Jan;3(1):23-30. doi: 10.1177/135581969800300107.
In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered.
The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index).
In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more.
It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.
20世纪90年代初，芬兰经济遭受严重衰退，与此同时医疗保健改革正在进行。本研究考察了这些变化对医疗保健筹资贡献分配与家庭收入关系的影响。并对当时医疗保健支出和使用的各种指标变化给出了解释。
分析部分基于实际收入数据，部分基于基年（1990年）的模拟数据。采用了能够估计不平等指数（基尼系数和卡克瓦尼累进性指数）置信区间的方法。
尽管衰退期间实际收入大幅下降，但收入分配几乎没有变化。纯粹由于结构变化，较贫困家庭在医疗保健总筹资中的份额有所增加。公共部门的财政困境导致累进所得税在总筹资中的份额下降，而累退间接税和家庭直接支付的贡献增加。
看来，除了较贫困家庭的筹资负担增加外，芬兰的医疗保健系统在很大程度上经受住了20世纪90年代初的巨大变化。这主要归因于税收资助的医疗保健系统的特点，该系统公平地分摊了财务和功能干扰的影响。
