Võrk Andres, Pažitný Peter, Waitzberg Ruth, Allin Sara, Behmane Daiga, Bouckaert Nicolas, Bricard Damien, Bryndová Lucie, Dimova Antoniya, Cascini Fidelia, Gaál Péter, Habimana Katharina, Kantaris Marios, Kocot Ewa, Kroneman Madelon, Murauskienė Liubovė, Or Zeynep, de Pietro Carlo, Saunes Ingrid S, Thomas Steve, Vrangbæk Karsten, Rice Thomas
School of Economics and Business Administration, University of Tartu, Narva Rd 18-4020, 51009 Tartu, Estonia.
Prague University of Economics and Business, Jarošovská 1117/II 37701, Jindřichův Hradec, Czech Republic.
Health Policy. 2025 Sep;159:105381. doi: 10.1016/j.healthpol.2025.105381. Epub 2025 Jun 22.
This study assesses progressivity in public and private health care revenue collection among 29 high-income countries by combining the results of two previous articles comprising this special section of Health Policy. In those studies, we developed qualitatively based scores regarding revenue collection policies for three public revenue sources (income taxes, social insurance contributions, consumption taxes) and two private revenue sources (voluntary health insurance, out-of-pocket payments).
The current study sums these scores, weighted by the shares of each revenue source in each country, to calculate an overall progressivity score for each country.
We derived weights for each revenue source using publicly available OECD and Eurostat macrolevel data on the structure of health care financing and government revenues.
France was the country that had the most progressive system, and Latvia, Hungary, and Bulgaria, the least progressive.
Countries relying more on out-of-pocket payments tend to be more regressive overall, suggesting that, from an equity perspective, their role should remain limited. Tax-based systems do not inherently ensure progressivity, especially when relying heavily on regressive consumption taxes. While wealthier countries and those with less income inequality tend to be more progressive, in contrast, Switzerland and Germany both scored among the more regressive countries. Our study shows that policy matters in promoting progressivity in health system revenue collection. Both public and private sources can be regressive if nothing is done. Yet, there are policy instruments that can mitigate regressivity, and even private sources of funds can be made less regressive.
本研究通过结合构成《卫生政策》这一特刊的两篇先前文章的结果，评估了29个高收入国家公共和私人医疗保健收入征收的累进性。在这些研究中，我们针对三种公共收入来源（所得税、社会保险缴款、消费税）和两种私人收入来源（自愿医疗保险、自付费用），制定了基于定性的收入征收政策得分。
本研究将这些得分相加，并根据每个国家每种收入来源的份额进行加权，以计算每个国家的总体累进性得分。
我们利用经合组织（OECD）和欧盟统计局（Eurostat）公开提供的关于医疗保健融资结构和政府收入的宏观层面数据，得出每种收入来源的权重。
法国的医疗体系累进性最强，而拉脱维亚、匈牙利和保加利亚的累进性最弱。
更多依赖自付费用的国家总体上往往更具累退性，这表明，从公平的角度来看，它们的作用应保持有限。基于税收的体系本身并不能确保累进性，尤其是在严重依赖累退性消费税的情况下。相比之下，较富裕的国家以及收入不平等程度较低的国家往往更具累进性，然而，瑞士和德国在累退性较强的国家中得分都较高。我们的研究表明，政策对于促进卫生系统收入征收的累进性至关重要。如果不采取任何措施，公共和私人收入来源都可能具有累退性。然而，有一些政策工具可以减轻累退性，甚至可以使私人资金来源的累退性降低。
