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Distributive effects of cost containment in health care

Objective

The project's aim was to generate evidence on the comparative performance - in terms of equity - of different health care financing and delivery systems.
The Concerted Action on distributive aspects of health care policies has studied equity in health care. Participants critically analysed various indicators used to measure inequality in health, with the following minimal requirements in mind: that the indicator reflects the socioeconomic dimension of inequalities in health; that it reflects the experiences of the entire population; that it be sensitive to changes in the distribution of the population across the socioeconomic groups. Of the indicators examined, only 2 were found to meet all 3 criteria: the slope index of equality (slope of the regression line showing the relationship between a class's health status and its relative rank in the socioeconomic distribution); the concentration index (calculated from the plot showing the cumulative proportions of the population versus the cumulative proportions of health). Another study appraised methods for measuring income based horizontal inequity in health care delivery are with respect to persons in equal need. None of the methods currently used was deemed very well equipped to provide unbiased estimates of the extent of inequity. A third problem examined was the equity efficiency trade off in health resource allocation. A concept oftern used in this context is the QALY, or quality adjusted life year. A policy objective underlying much QALY literature is maximisation of community health, measured as a sum of QALYs. This approach is criticised for taking into account only resource allocation concerns and thus ignoring equity issues. A QALY based social welfare function was proposed as a means of incorporating both types of concern into resource allocation decisions.
Until recently, the few cross-country comparisons of health care finance that had been undertaken focused primarily on issues such as cost containment. As a result, comparatively little was known about the equity characteristics of alternative health care financing and delivery systems, and about the likely equity implications of reforms to these systems. This Concerted Action (CA) went some way towards filling this gap by investigating the equity characteristics of 10 health care systems.

Besides its focus on equity, three other features of the project distinguish it from previous cross-country comparisons. One is that, in contrast to previous empirical studies of a comparative nature, which have almost all been based on aggregate data, the present study employs micro-level data. A second feature of the present study is that those participating have together developed and then applied a common methodology. There is, as a result, a high degree of comparability in the empirical results. Differences in results ought therefore to reflect genuine differences between countries rather than differences in methods. A third feature of the project is that the analysis for each of the 10 countries has been undertaken, for the most part, by research teams from the country in question. This contrasts with previous comparative studies in the health field where one or two researchers have invariably performed the analysis for all the countries in the study.

Coordinator

Erasmus University Rotterdam
Address
Po Box 1738
3000 DR Rotterdam
Netherlands