Most research on health care equity focuses on accessing services, with less attention given to how revenue is collected to pay for a country's health care bill. This article examines the progressivity of revenue collection among publicly funded sources: income taxes, social insurance (often in the form of payroll) taxes, and consumption taxes (e.g., value-added taxes). We develop methodology to derive a qualitative index that rates each of 29 high-income countries as to its progressivity or regressivity for each of the three sources of revenue. A variety of data sources are employed, some from secondary data sources and other from country representatives of the Health Systems and Policy Monitor of the European Observatory on Health Systems and Policies. We found that countries with more progressive income tax systems used more income-based tax brackets and had larger differences in marginal tax rates between the brackets. The more progressive social insurance revenue collection systems did not have an upper income cap and exempted poorer persons or reduced their contributions. The only pattern regarding consumption taxes was that countries that exhibited the fewest overall income inequalities tended to have least regressive consumption tax policies. The article also provides several examples from the sample of countries on ways to make public revenue financing of health care more progressive.
- MeSH
- daň z příjmu ekonomika MeSH
- daně * ekonomika MeSH
- financování vládou * MeSH
- lidé MeSH
- poskytování zdravotní péče ekonomika MeSH
- sociální zabezpečení ekonomika MeSH
- vyspělé země MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- důchody MeSH
- lidé MeSH
- psychický stres psychologie MeSH
- roztroušená skleróza * psychologie MeSH
- sociální zabezpečení * MeSH
- svépomocné skupiny trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
IMPORTANCE: Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. OBJECTIVE: To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. EXPOSURE: Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. MAIN OUTCOMES AND MEASURES: Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. RESULTS: The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. CONCLUSIONS AND RELEVANCE: In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.
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- cyklonové bouře * statistika a číselné údaje MeSH
- domy s pečovatelskou službou * statistika a číselné údaje MeSH
- hospitalizace statistika a číselné údaje MeSH
- lidé MeSH
- Medicare statistika a číselné údaje MeSH
- pečovatelské domovy statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- urgentní služby nemocnice statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Florida MeSH
- Spojené státy americké MeSH
- MeSH
- dieta ekonomika MeSH
- dlouhodobá péče ekonomika organizace a řízení MeSH
- lidé MeSH
- pojištění při dlouhodobé péči MeSH
- sociální zabezpečení * dějiny organizace a řízení zákonodárství a právo MeSH
- úhrada zdravotního pojištění * ekonomika klasifikace statistika a číselné údaje zákonodárství a právo MeSH
- zákonodárství jako téma MeSH
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- lidé MeSH
- Klíčová slova
- pracovní právo,
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- cestování zákonodárství a právo MeSH
- lidé MeSH
- odškodnění pracovníků * zákonodárství a právo MeSH
- pracoviště zákonodárství a právo MeSH
- pracovní nehody zákonodárství a právo MeSH
- pracovní síly zákonodárství a právo MeSH
- pracovní úrazy prevence a kontrola MeSH
- právní odpovědnost MeSH
- zákonodárství jako téma MeSH
- Check Tag
- lidé MeSH
- MeSH
- důchody MeSH
- lidé MeSH
- návrat do práce MeSH
- nemoci z povolání ekonomika MeSH
- odškodnění pracovníků * ekonomika zákonodárství a právo MeSH
- posuzování pracovní neschopnosti MeSH
- práce zákonodárství a právo MeSH
- pracovní úrazy * ekonomika MeSH
- právní odpovědnost MeSH
- vzdělávání odborné - rekvalifikace zákonodárství a právo MeSH
- zákonodárství jako téma MeSH
- Check Tag
- lidé MeSH
