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.

Belgian Health Care Knowledge Kruidtuinlaan 55 1000 Brussels Belgium

Department of Applied Social Sciences Faculty of Technical and Human Sciences Sapientia Hungarian University of Transylvania Marosvásárhely Koronka 540485 Târgu Mureş Op 9 Cp 4 Hungary

Department of Health Care Management Berlin University of Technology Straße des 17 Juni 135 10623 Berlin

Department of Health Policy and Management UCLA Fielding School of Public Health Los Angeles CA USA

Department of Life Sciences and Public Health Catholic University of the Sacred Heart Rome Italy

Department of Public Health Institute of Health Sciences Faculty of Medicine Vilnius University M K Čiurlionio str 21 LT 03101 Vilnius Lithuania

Faculty of Management Prague University of Economics and Business Jarošovská 1117 2 377 01 Jindřichův Hradec Czech Republic

Faculty of Social Sciences Charles University U Kříže 8 158 00 Prague 5 Czech Republic

Health Economics and Social Security Department Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Skawinska 8 31 066 Krakow Poland

Health Services Management Training Centre Faculty of Health and Public Administration Semmelweis University 1428 Budapest PO Box 2 Hungary

Health Services Research University of Copenhagen CSS Øster Farimagsgade 5 1353 Copenhagen K Denmark

Institut de Rrecherche et Documentation en Economie de la Santé 21 23 Rue des Ardennes 75019 Paris France

Medical University Varna 55 Marin Drinov Str 9002 Varna Bulgaria

Norwegian Institute of Public Health PO Box 222 Skøyen N 0213 Oslo Norway

School of Economics and Business Administration University of Tartu Lossi 36 Tartu 51003 Estonia

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