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Mar 20, 2008
Tyler Cowen alerted me to this NBER Working Paper by Sherry Glied. (Unfortunately, the full report is gated.) Based on an analysis of data from 20 developed countries, she concludes:
- There is no general relationship between the way in which countries pay for health care and their ability to control costs. Public v. private financing, general revenue v. payroll taxes, third-party v. out-of-pocket spending - nothing seems to matter very much.
- Government provision of health care is only modestly progressive. In Canada, people in the bottom two income quintiles - with 40% of the population - get about 50% of the health care benefits. Moreover, relative to health care needs, Canada's health care spending may not be progressive at all. For OECD countries generally, among people with similar health conditions, "higher income people use the system more intensively and use more costly services than do lower income people."
- Marginal increases in health care spending may actually be regressive. This is especially true if extra spending buys specialist services and elective procedures. "In Canada, high income people make disproportionate use of elective surgical procedures, such as hip and knee replacements."
- Government provision of health care has little impact on the distribution of well-being in society. When economists assign a monetary value to health care and add it to money income, national health insurance has very little impact on overall economic inequality.
- Increases in health care spending crowd out other government spending. Redistribution through government-funded health care partly replaces other redistributive government programs. What low-income people gain in health services may be offset by reductions, say, in housing or education benefits.
Here is the bottom line: "A mixed financing system [i.e., one that combines public and private insurance] may be the optimal way to balance efficiency and equity in health care."
7 Responses to “Five Fascinating Results”
March 24th, 2008 at 11:04 am
My experience in Canada indicates that the health care is average at best and very expensive. An aunt waited 2 years in pain for a knee replacement. My brother in law was in hospital over 2 weeks with a broken hip waiting for a replacement. The only doctor was away at the time. Long waits for elective surgery are the norm. There are no real incentives to do more. “Near enough is good enough”.
March 25th, 2008 at 2:30 pm
The bottom line is everyone should read it, reread it, and re-reread it.
March 28th, 2008 at 7:32 am
When sorting out or analyzing garbage, what is one left with?
August 18th, 2008 at 5:40 pm
Just give everyone Medicare type coverage (using the existing system) and let the health savings accounts take care of the rest of the problems). The private and subsidized worlds could help each other. I have been a private health care provider for 35 years. Socialized medicine is not the same as national health insurance. For every horror story you can find about nationalized health insurance their are more with our system. If we stopped paying for our elected officials insurance you would see a solution.
August 19th, 2008 at 12:44 pm
The “bottom line” given doesn’t follow from the evidence presented. I suppose if you take the “may be” part really seriously you can argue that the statement is true, but then so is every other plausible conclusion.
August 26th, 2008 at 4:49 pm
So, you are you going to fix the shitty health care system then smarty mcgee?
I see a lot of talk, but no solutions.
September 4th, 2008 at 3:42 pm
Point #1 is irrelevant to a policy discussion in this country. What matters is that in THIS country, we are terrible at controlling costs. We need to be open to all options. In fact, almost every point above is misleading or irrelevant to our current situation.