Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD

This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960-2006 to assess the effects of adopting social health insurance over tax finance on per capita health spendin...

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Main Author:	Wagstaff, Adam
Format:	Policy Research Working Paper
Language:	English
Published:	2012
Subjects:	AGE GROUPS AGED BREAST CANCER CANCERS CAPITA HEALTH SPENDING CAPITATION CAPITATION SYSTEM CAUSES OF DEATH CERVICAL CANCER COLON CANCER COMPARISONS OF HEALTH EXPENDITURE COMPETITION BETWEEN HOSPITALS DEATH RATE DEATH RATES DEATHS DEMOCRACY DEVELOPING COUNTRIES DIABETES DIAGNOSIS DISEASES EARLY DETECTION EXPENDITURES FEE-FOR-SERVICE FEMALES GLOBAL BUDGETS HEALTH AUTHORITIES HEALTH CARE HEALTH CARE COSTS HEALTH CARE COVERAGE HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH CARE SYSTEM HEALTH CARE SYSTEMS HEALTH CARE SYSTEMS IN TRANSITION HEALTH CARE UTILIZATION HEALTH DATA HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH FINANCE HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH IMPACTS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH INSURANCE FUNDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SERVICES RESEARCH HEALTH STATUS HEALTH STATUS INDICATORS HEALTH SYSTEM HEALTH SYSTEMS HEALTH SYSTEMS IN TRANSITION HEART DISEASE HOSPITAL HOSPITALS HUMAN DEVELOPMENT ILLNESS IMMUNIZATIONS INCOME INCOME COUNTRIES INDIVIDUAL MEMBERS INEQUITIES INEQUITIES IN HEALTH CARE INFLUENZA INFORMAL SECTOR INFORMAL SECTOR WORKERS INPATIENT ADMISSIONS INSURANCE MARKET INSURANCE SCHEMES INSURANCE SYSTEMS INSURERS INTEGRATION INTERNATIONAL COMPARISONS LABOR MARKET LABOR MARKETS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY MALIGNANT NEOPLASMS MARKET ECONOMY MATERNAL DEATH MEDICAL CARE MORTALITY NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL HEALTH SPENDING NUMBER OF PEOPLE PATIENTS PERSONAL HEALTH PHYSICIANS PNEUMONIA POCKET PAYMENTS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION STUDIES PREGNANCY PREMATURE DEATH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH CARE PROVISION OF SERVICES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC SERVICES PURCHASER-PROVIDER SPLIT PURCHASING POWER QUALITY CARE QUALITY OF CARE RESPECT RISK ADJUSTMENT SCREENING SHARE OF HEALTH SPENDING SICKNESS FUNDS SOCIAL HEALTH INSURANCE SOCIAL SECURITY TREATMENT TUBERCULOSIS TUBERCULOSIS CONTROL UNEMPLOYMENT WAR WORKERS WORKING-AGE POPULATION WORLD HEALTH ORGANIZATION
Online Access:	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20090121101737 http://hdl.handle.net/10986/4018

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spelling	okr-10986-40182021-04-23T14:02:14Z Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD Wagstaff, Adam AGE GROUPS AGED BREAST CANCER CANCERS CAPITA HEALTH SPENDING CAPITATION CAPITATION SYSTEM CAUSES OF DEATH CERVICAL CANCER COLON CANCER COMPARISONS OF HEALTH EXPENDITURE COMPETITION BETWEEN HOSPITALS DEATH RATE DEATH RATES DEATHS DEMOCRACY DEVELOPING COUNTRIES DIABETES DIAGNOSIS DISEASES EARLY DETECTION EXPENDITURES FEE-FOR-SERVICE FEMALES GLOBAL BUDGETS HEALTH AUTHORITIES HEALTH CARE HEALTH CARE COSTS HEALTH CARE COVERAGE HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH CARE SYSTEM HEALTH CARE SYSTEMS HEALTH CARE SYSTEMS IN TRANSITION HEALTH CARE UTILIZATION HEALTH DATA HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH FINANCE HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH IMPACTS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH INSURANCE FUNDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SERVICES RESEARCH HEALTH STATUS HEALTH STATUS INDICATORS HEALTH SYSTEM HEALTH SYSTEMS HEALTH SYSTEMS IN TRANSITION HEART DISEASE HOSPITAL HOSPITALS HUMAN DEVELOPMENT ILLNESS IMMUNIZATIONS INCOME INCOME COUNTRIES INDIVIDUAL MEMBERS INEQUITIES INEQUITIES IN HEALTH CARE INFLUENZA INFORMAL SECTOR INFORMAL SECTOR WORKERS INPATIENT ADMISSIONS INSURANCE MARKET INSURANCE SCHEMES INSURANCE SYSTEMS INSURERS INTEGRATION INTERNATIONAL COMPARISONS LABOR MARKET LABOR MARKETS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY MALIGNANT NEOPLASMS MARKET ECONOMY MATERNAL DEATH MEDICAL CARE MORTALITY NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL HEALTH SPENDING NUMBER OF PEOPLE PATIENTS PERSONAL HEALTH PHYSICIANS PNEUMONIA POCKET PAYMENTS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION STUDIES PREGNANCY PREMATURE DEATH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH CARE PROVISION OF SERVICES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC SERVICES PURCHASER-PROVIDER SPLIT PURCHASING POWER QUALITY CARE QUALITY OF CARE RESPECT RISK ADJUSTMENT SCREENING SHARE OF HEALTH SPENDING SICKNESS FUNDS SOCIAL HEALTH INSURANCE SOCIAL SECURITY TREATMENT TUBERCULOSIS TUBERCULOSIS CONTROL UNEMPLOYMENT WAR WORKERS WORKING-AGE POPULATION WORLD HEALTH ORGANIZATION This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960-2006 to assess the effects of adopting social health insurance over tax finance on per capita health spending, amenable mortality, and labor market outcomes. The paper uses regression-based generalizations of difference-in-differences and instrumental variables to address the possible endogeneity of a country's health system. It finds that adopting social health insurance in preference to tax financing increases per capita health spending by 3-4 percent, reduces the formal sector share of employment by 8-10 percent, and reduces total employment by as much as 6 percent. For the most part, social health insurance adoption has no significant impact on amenable mortality, but for one cause-breast cancer among women-social health insurance systems perform significantly worse, with 5-6 percent more potential years of life lost. 2012-03-19T19:08:26Z 2012-03-19T19:08:26Z 2009-01-01 http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20090121101737 http://hdl.handle.net/10986/4018 English Policy Research working paper ; no. WPS 4821 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank Publications & Research :: Policy Research Working Paper East Asia and Pacific
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English
topic	AGE GROUPS AGED BREAST CANCER CANCERS CAPITA HEALTH SPENDING CAPITATION CAPITATION SYSTEM CAUSES OF DEATH CERVICAL CANCER COLON CANCER COMPARISONS OF HEALTH EXPENDITURE COMPETITION BETWEEN HOSPITALS DEATH RATE DEATH RATES DEATHS DEMOCRACY DEVELOPING COUNTRIES DIABETES DIAGNOSIS DISEASES EARLY DETECTION EXPENDITURES FEE-FOR-SERVICE FEMALES GLOBAL BUDGETS HEALTH AUTHORITIES HEALTH CARE HEALTH CARE COSTS HEALTH CARE COVERAGE HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH CARE SYSTEM HEALTH CARE SYSTEMS HEALTH CARE SYSTEMS IN TRANSITION HEALTH CARE UTILIZATION HEALTH DATA HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH FINANCE HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH IMPACTS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH INSURANCE FUNDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SERVICES RESEARCH HEALTH STATUS HEALTH STATUS INDICATORS HEALTH SYSTEM HEALTH SYSTEMS HEALTH SYSTEMS IN TRANSITION HEART DISEASE HOSPITAL HOSPITALS HUMAN DEVELOPMENT ILLNESS IMMUNIZATIONS INCOME INCOME COUNTRIES INDIVIDUAL MEMBERS INEQUITIES INEQUITIES IN HEALTH CARE INFLUENZA INFORMAL SECTOR INFORMAL SECTOR WORKERS INPATIENT ADMISSIONS INSURANCE MARKET INSURANCE SCHEMES INSURANCE SYSTEMS INSURERS INTEGRATION INTERNATIONAL COMPARISONS LABOR MARKET LABOR MARKETS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY MALIGNANT NEOPLASMS MARKET ECONOMY MATERNAL DEATH MEDICAL CARE MORTALITY NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL HEALTH SPENDING NUMBER OF PEOPLE PATIENTS PERSONAL HEALTH PHYSICIANS PNEUMONIA POCKET PAYMENTS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION STUDIES PREGNANCY PREMATURE DEATH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH CARE PROVISION OF SERVICES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC SERVICES PURCHASER-PROVIDER SPLIT PURCHASING POWER QUALITY CARE QUALITY OF CARE RESPECT RISK ADJUSTMENT SCREENING SHARE OF HEALTH SPENDING SICKNESS FUNDS SOCIAL HEALTH INSURANCE SOCIAL SECURITY TREATMENT TUBERCULOSIS TUBERCULOSIS CONTROL UNEMPLOYMENT WAR WORKERS WORKING-AGE POPULATION WORLD HEALTH ORGANIZATION
spellingShingle	AGE GROUPS AGED BREAST CANCER CANCERS CAPITA HEALTH SPENDING CAPITATION CAPITATION SYSTEM CAUSES OF DEATH CERVICAL CANCER COLON CANCER COMPARISONS OF HEALTH EXPENDITURE COMPETITION BETWEEN HOSPITALS DEATH RATE DEATH RATES DEATHS DEMOCRACY DEVELOPING COUNTRIES DIABETES DIAGNOSIS DISEASES EARLY DETECTION EXPENDITURES FEE-FOR-SERVICE FEMALES GLOBAL BUDGETS HEALTH AUTHORITIES HEALTH CARE HEALTH CARE COSTS HEALTH CARE COVERAGE HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH CARE SYSTEM HEALTH CARE SYSTEMS HEALTH CARE SYSTEMS IN TRANSITION HEALTH CARE UTILIZATION HEALTH DATA HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH FINANCE HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH IMPACTS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH INSURANCE FUNDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SERVICES RESEARCH HEALTH STATUS HEALTH STATUS INDICATORS HEALTH SYSTEM HEALTH SYSTEMS HEALTH SYSTEMS IN TRANSITION HEART DISEASE HOSPITAL HOSPITALS HUMAN DEVELOPMENT ILLNESS IMMUNIZATIONS INCOME INCOME COUNTRIES INDIVIDUAL MEMBERS INEQUITIES INEQUITIES IN HEALTH CARE INFLUENZA INFORMAL SECTOR INFORMAL SECTOR WORKERS INPATIENT ADMISSIONS INSURANCE MARKET INSURANCE SCHEMES INSURANCE SYSTEMS INSURERS INTEGRATION INTERNATIONAL COMPARISONS LABOR MARKET LABOR MARKETS LEVEL OF HEALTH SPENDING LIFE EXPECTANCY MALIGNANT NEOPLASMS MARKET ECONOMY MATERNAL DEATH MEDICAL CARE MORTALITY NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL HEALTH SPENDING NUMBER OF PEOPLE PATIENTS PERSONAL HEALTH PHYSICIANS PNEUMONIA POCKET PAYMENTS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION STUDIES PREGNANCY PREMATURE DEATH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH CARE PROVISION OF SERVICES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC SERVICES PURCHASER-PROVIDER SPLIT PURCHASING POWER QUALITY CARE QUALITY OF CARE RESPECT RISK ADJUSTMENT SCREENING SHARE OF HEALTH SPENDING SICKNESS FUNDS SOCIAL HEALTH INSURANCE SOCIAL SECURITY TREATMENT TUBERCULOSIS TUBERCULOSIS CONTROL UNEMPLOYMENT WAR WORKERS WORKING-AGE POPULATION WORLD HEALTH ORGANIZATION Wagstaff, Adam Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
geographic_facet	East Asia and Pacific
relation	Policy Research working paper ; no. WPS 4821
description	This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960-2006 to assess the effects of adopting social health insurance over tax finance on per capita health spending, amenable mortality, and labor market outcomes. The paper uses regression-based generalizations of difference-in-differences and instrumental variables to address the possible endogeneity of a country's health system. It finds that adopting social health insurance in preference to tax financing increases per capita health spending by 3-4 percent, reduces the formal sector share of employment by 8-10 percent, and reduces total employment by as much as 6 percent. For the most part, social health insurance adoption has no significant impact on amenable mortality, but for one cause-breast cancer among women-social health insurance systems perform significantly worse, with 5-6 percent more potential years of life lost.
format	Publications & Research :: Policy Research Working Paper
author	Wagstaff, Adam
author_facet	Wagstaff, Adam
author_sort	Wagstaff, Adam
title	Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
title_short	Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
title_full	Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
title_fullStr	Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
title_full_unstemmed	Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD
title_sort	social health insurance vs. tax-financed health systems—evidence from the oecd
publishDate	2012
url	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20090121101737 http://hdl.handle.net/10986/4018
_version_	1764389524177158144

Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD

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