The progressivity of health care revenue financing in 29 countries: A comparison

Andres Võrk (), Peter Pažitný (), Ruth Waitzberg (), Sara Allin (), Daiga Behmane (), Nicolas Bouckaert (), Damien Bricard (), Lucie Bryndová, Antoniya Dimova (), Fidelia Cascini (), Péter Gaál (), Katharina Habimana (), Marios Kantaris (), Ewa Kocot (), Madelon Kroneman, Liubovė Murauskienė (), Zeynep Or (), Carlo de Pietro (), Ingrid Saunes (), Steve Thomas (), Karsten Vrangbæk and Thomas Rice ()
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Damien Bricard: MRE - Montpellier Recherche en Economie - UM - Université de Montpellier
Zeynep Or: IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres

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Abstract: Background: 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).Objective: 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.Methods: 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.Results: France was the country that had the most progressive system, and Latvia, Hungary, and Bulgaria, the least progressive.Conclusions: 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. Taxbased 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

Keywords: Equity; Progressivity; Health care financing; Public funding; Private funding (search for similar items in EconPapers)
Date: 2025-09
Note: View the original document on HAL open archive server: https://hal.science/hal-05301753v1
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Published in Health Policy, 2025, 159, pp.105381. ⟨10.1016/j.healthpol.2025.105381⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05301753

DOI: 10.1016/j.healthpol.2025.105381

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