Research project SO/01/005 (Research action SO)
(I) Time analysis of private payments for health care
A first task of the project consists in analysing private payments for health care over time. On the basis of household budget surveys, a clearer insight can be obtained into the number of private payments over time, and the relative income share involved. The analysis can provide an answer to the question of to what degree increased non-refundable parts of medical expenses are being offset by measures such as the fiscal and social deductible.
(ii) Characteristics of vulnerable groups for health care payments
Secondly, the profile of vulnerable groups for medical care payment will be defined in the research. There is evidence that an increasing number of patients are having difficulties paying for their health care (hospital bills). Various measures have therefore been taken for specific patient groups and for specific circumstances. However, it is unclear to what degree these specific measures reach the most vulnerable groups. Primarily problems with psychiatric patients or non-reimbursed medications or interventions have often been noted, but until now have not been verified. More information about patients with payment difficulties is needed before strategies can be developed to solve this problem. The second objective of the research is to verify the characteristics of these patients.
In order to investigate the relative significance of payment problems for uninsured patients, a file with exclusive information of all patients with invoices included in an instalment plan or outstanding invoices after two reminders will be analysed as a control.
(iii) Vertical and horizontal fairness in health care financing
Most people generally agree that medical care should be financed according to ability to pay. Whether or not health care is pro(re)gressively financed depends on the pro(re)gressivity of the various financing sources and their relative share. The household budget survey can be used to investigate the progressivity of the most important financing sources: social security contributions, direct taxes, indirect taxes and own payments. It will then be possible to gain insight into the overall progressivity / regressivity of the current system and into the equitable consequences of changes in the payment system or in the payment mix.
However, it is not solely vertical fairness which is of importance. Horizontal fairness is equally significant. Horizontal fairness refers to the spread of the effective payments within each income level. Thus, it is altogether possible that social security payments are horizontally unfair, because households with the same income pay different contributions, because they belong to different systems (general system versus the system for independents). The same can be said of direct payments: they can vary between families with the same income because of differences in social security status, different choices with regard to private insurance, and/or differences in disease prevention.
The specific tasks of the PROJECT are the following:
A. Time analysis of private payments for health care
A.1 Prepare family budget survey for use
A.2 Time analysis of scope of payments
B. Characteristics of vulnerable groups for health care payments
B.1 Expansion of MISIM simulation model
B.2 Description of vulnerable groups by means of analysis of unpaid invoices
B.3 Description of vulnerable groups by means of analysis of the family budget survey
C. Vertical and horizontal fairness in health care financing
C.1 Research on the progressivity of health care financing
C.2 MISIM model: simulation of direct taxes and social security
C.3 ASTER model: simulation of indirect taxes
L'équité dans le financement des soins de santé : résumé
Bruxelles : Politique scientifique fédérale, 2003 (SP1219)
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Billijkheid in de financiering van gezondheidszorg : samenvatting
Brussel : Federaal wetenschapsbeleid, 2003 (SP1220)
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Equity in the Finance of Healthcare : summary
Brussels : Federal Science Policy Office, 2003 (SP1221)
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Billijkheid in de financiering van medische zorg : eindrapport
Brussel : Federaal wetenschapsbeleid, 2003 (SP1222)
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Bibliografic references :
