Dixon a fugueras j and kutzin j eds funding health

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Dixon A, Fugueras, J and Kutzin, J. (eds) Funding Health Care: Options for Europe , European Observatory on Health Care Systems, OUP, 2002. Also see Jacobs, R. and Goddard, M. Social Health Insurance Systems in European Countries . University of York Centre for Health Economics, 2000. 4 Mossialos and Dixon et al (2002), p 287. Citing Gruber J. and Krueger, A.B. (1991), The incidence of mandated employer-provided insurance: lessons from workers’ compensation insurance, in D. Bradford (ed.) Tax Policy and the Economy . Cambridge, MA: MIT Press. Gruber, J. (1998) Health Insurance and the Labor Market, Cambridge, MA: National Bureau of Economic Research, Inc. Bauer, T. and Riphahn, R.T. (1998) Employment Effects of Payroll Taxes - An Empirical Test for Germany, Bonn: Institute for the Study of Labor (IZA). MYTH-BUSTING ON ALTERNATIVE HEALTHCARE FUNDING The NHS is free. Wrong. The NHS costs the average household £2400 per year . That is roughly £1000 per person . Health care in the UK is based on need, not ability to pay. Wrong. In reality, access to care in the UK is influenced by age, gender, education, race, class and wealth. We have a multi- tier system. Almost all developed countries claim that their citizens have access to healthcare on the basis of need, not ability to pay. To continue impliedly asserting that the NHS is different in this respect is dishonest. Many countries can make this claim with more authority than the UK. All social insurance systems are the same . Wrong. Social insurance systems have four common features: universality (compulsory insurance with subsidisation of the sick by the healthy), price regulation (to ensure risk solidarity – usually combined with some form of risk compensation for insurers with relatively many high-risk insured), open enrollment, and a defined and regulated benefits package. Social insurance comes in two main forms: multiple and single third-party-payer models. Each of these has a number of possible varieties. For example, in the multiple payer model, there may or may not be competition between funds. 3 Social insurance is just another tax. Wrong. The third party payer in social insurance systems typically represents the interests of employers and patients. In the UK, the Treasury is the third party payer and has interests of its own, which do not coincide with those of healthcare consumers. By the same token, the important difference between national general, and local hypothecated taxation must be noted; the latter is much more like social insurance. Social insurance is a tax on jobs. Wrong. Swiss social health insurance is not reliant on employer contributions and therefore is not a tax on jobs. Mossialos and Dixon (2002) further challenge this myth by citing studies from the US and Germany which show little or no effect on employment levels of employer health insurance contributions or employer- provided insurance benefits. 4
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7 5 See Mossialos, Dixon et al (2002) p288-90.
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