This article summarises, extends and updates previous empirical work on the distributional implications of alternative health care financing arrangements in a selection of European countries and the US. On the one hand, total health care payments are almost proportional to ability to pay in most countries. This is predominantly driven by a high reliance on public financing. On the other hand, private payments – out-of-pocket payments as well as private insurance premiums – are highly regressive. More extended reliance on private financing may therefore endanger the equitable nature of financing systems. In addition, private payments put a heavy burden on unfortunate households.

Health economics,
The World Economy
Erasmus School of Economics

de Graeve, D, & van Ourti, T.G.M. (2003). The distributional impact of health financing in Europe: A Review'. The World Economy, 26(10), 1459–1479. doi:10.1111/j.1467-9701.2003.00582.x