Mitigating the regressivity of private mechanisms of financing healthcare: An Assessment of 29 countries.

Progressive financing of health care can help advance the equity and financial protection goals of health systems. All countries' health systems are financed in part through private mechanisms, including out-of-pocket payments and voluntary health insurance. Yet little is known about how these financing schemes are structured, and the extent to which policies in place mitigate regressivity. This study identifies the potential policies to mitigate regressivity in private financing, builds two qualitative tools to comparatively assess regressivity of these two sources of revenue, and applies this tool to a selection of 29 high-income countries. It provides new evidence on the variations in policy approaches taken, and resultant regressivity, of private mechanisms of financing health care. These results inform a comprehensive assessment of progressivity of health systems financing, considering all revenue streams, that appears in this special section of the journal.

Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries.

INTRODUCTION: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). OBJECTIVES: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. METHODS: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. RESULTS: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. DISCUSSION AND CONCLUSIONS: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Misreporting and misclassification: implications for socioeconomic disparities in body-mass index and obesity.

Body-mass index (BMI) has become the standard proxy for obesity in social science research. This study deals with the potential problems related to, first, relying on self-reported weight and height to calculate BMI (misreporting), and, second, the concern that BMI is a deficient measure of body fat (misclassification). Using a regional Swedish sample, we analyze whether socioeconomic disparities in BMI are biased because of misreporting, and whether socioeconomic disparities in the risk of obesity are sensitive to whether BMI or waist circumference is used to define obesity. Education and income are used as socioeconomic indicators. The overall conclusion is that misreporting and misclassification may indeed matter for estimated educational and income disparities in BMI and obesity. In the misreporting part we find that women with higher education misreport less than those with lower education, leading to underestimation of the education disparity when using self-reported information. In the misclassification part we find that the probability of being misclassified decreases with income, for both men and women. Among women, the consequence is a steeper income gradient when obesity is defined using waist circumference instead of BMI. Among men the income gradient is statistically insignificant irrespective of how obesity is defined, but when estimating the probability of obesity defined by waist circumference, an educational gradient, which is not present when classifying men using BMI, arises.

Bigger bodies: long-term trends and disparities in obesity and body-mass index among U.S. adults, 1960-2008.

Increasing obesity rates and corresponding public health problems are well-known, and disparities across socioeconomic groups are frequently reported. However, the literature is less clear on whether the increasing trends are specific to certain socioeconomic groups and whether disparities in obesity are increasing or decreasing over time. This knowledge sheds light on the understanding of the driving forces to the ongoing worldwide increases in obesity and body-mass index and gives guidance to plausible interventions aiming at reverting weights back to healthy levels. The purpose of this study is to explore long-term time trends and socioeconomic disparities in body-mass index and obesity among U.S. adults. Individual level data from ten cycles of the National Health and Nutrition Examination Survey between 1960 and 2008 are used to estimate adjusted time trends in the probabilities of obesity and severe obesity and in measured body-mass index for three racial/ethnical groups, for three educational groups, and for four levels of income, stratified by gender. Time trends in the probabilities of obesity and severe obesity are estimated by linear probability models, and trends at the 15th, 50th and 85th percentiles of the adjusted body-mass index distribution are estimated by quantile regression. Divergent time trends for the different socioeconomic groups are estimated by interaction terms between socioeconomic status and year. The results show that, with some exceptions, increases in both obesity, severe obesity and body-mass index are similar across the different racial/ethnic, educational and income groups. We conclude that the increase in body-mass index and obesity in the United States is a true epidemic, whose signal hallmark is to have affected an entire society. Accordingly, a whole-society approach is likely to be required if the increasing trends are to be reversed.

More equal but heavier: a longitudinal analysis of income-related obesity inequalities in an adult Swedish cohort.

Using longitudinal data over a 17-year period for a Swedish cohort aged 20-68 in 1980/1981, this study analyses income-related inequalities in obesity. By using the concentration index and decomposition techniques we answer the following questions: We find that among females, inequalities in obesity favour the rich, but the inequality declines over time. Income itself is the main driving force behind obesity inequality, whereas being single (as opposed to being married or cohabiting) is an important counteracting factor. The main reason for the reduced obesity inequality over time is increased obesity prevalence, because in absolute terms obesity has increased uniformly across income groups. Because the income elasticity of obesity is the single most important contributor to the inequality, policies directed towards this factor might be the most effective for reducing obesity inequality. Our main income variable is within-individual mean of income, and we thereby focus on long-run inequality and are able to standardize for income mobility. The results show that inequality based on short-run income differs substantially from inequality based on long-run income. For males we find similar inequality trends as for women, although less pronounced. This difference between men and women should be taken into account when evaluating obesity reducing policies.