Ch 12.docx

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University of Toronto Mississauga
Multiple Professors

Ch 12 Achieving Universla Coveragecrosssubsidization a situation arising when the funds of different population groups risk pools are pooledformal sector employees members of the population who are employed with a taxable incomefragmentation a situation whereby there are many financing schemes which operate as separate risk pools with limited crosssubsidizationprogressive a financing mechanisms is described as progressive if it consumes a greater proportion of the income of the rich than the poorregressive a financing mechanism is described as regressive if it consumes a greater proportion of the income of the poor than the richWhat is universal coverageyou identified that one of the key drawbacks in a system that uses predominantly private health insurance are problems of advserse selection and access to care for the poorThe focus of universal coverage is on providing protection from paying for health care outofpocket at the time of service use and especially protection from incurring catastrophic health expenditures or expenditures which exceed a certain proportion of income and can push a household into povertyideally the concept of universal coverage therefore implies equity of access and financial equity in financingrisk protection It is also based on the notion ofie contributions are based on ability to pay rather than according to whether a person falls illEquity in health care financingwhen considering who is bearing the burden of health care financing it is common practice to compare contributions against ability to pay measured in terms of incomethe extent to which contirbutions to health care vary with ability to pay is typically defined in relation to 3 concepts1 progressive contributions to health care are considred to be progressive if the richest segment of the population contributes a higher proportion of their income than the poorest This is the principle underlying the system of income tax in most countries2 regressive contributions are said to be regressive if the rich pay a relatively smaller share of their income than the poor3 Proportional if everyone is contribution the same proportion of their income then the contribution is said to be proportionalTaking account of varying levels of need in the distribution of health benefits when we talk about equity of health care utilization access or expenditure it usually discussed in terms of need ex Equal access for equal needwe know that the poorest groups in society have the greatest need for health care due to their economic vulnerability which makes them more prone to illnessideally then we would expect the poorest 20 of the population to get more than 20 of the benefits of health care in line with their needgenerally if the poorest 20 of the population get less than 20 of the health benefits and the wealthiest 20 get more than 20 of the benefits we define the distribution of benefits as being Prorichif the poorest 20 of the population get more than 20 of the benefits with richer groups getting less than 20 we define the bistribtion of benefits as being propoorpropoor policies that target disadvantaged groups by treating people differently according to their needs are underpinned by the principle of vertical equity
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