Marisol Rodríguez

Income-related inequalities in health: some international comparisons

This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.

Equity in the finance of health care: some further international comparisons

This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.

Redistributive effect progressivity and differential tax treatment: personal income taxes in twelve OECD countries

This paper decomposes the redistributive effect of the personal income taxes (PITs) of twelve OECD countries into four components: (i) an average rate effect, (ii) a departure-from-proportionality or progressivity effect, (iii) a horizontal equity effect and (iv) a reranking effect. The product of (i) and (ii) indicates the vertical redistribution associated with the PIT and the sum of (iii) and (iv) indicates the impact on the distribution of income of differential tax treatment. The average tax rate is found to be low in France and high in the Nordic countries, and the PIT is found to be most progressive in France, Ireland and Spain, and least progressive in Denmark and Sweden. Taking (i) and (ii) together, Denmark and the US achieve broadly similar levels of vertical redistributive effect. Differential treatment is found to have a much smaller effect on income redistribution (as a proportion of redistributive effect) than the vertical redistribution caused by progressivity, though there are differences between countries. These differences appear to be due principally to a different emphasis on deductions, such as tax deductibility of mortgage interest payments and insurance premiums, and on local income tax.

An update on Spain’s health care system: is it time for managed competition?

Using national data and the most recent OECD figures, we provide an updated assessment of the Spanish health care system and its reforms. We compare figures from Spain with other major industrialized nations and find that the Spanish system appears macro-economically efficient and equitable. However, like many other countries in Europe and elsewhere, the Spanish health care system confronts continued pressures to provide high-quality universal care in the face of ever increasing costs and competing uses for financial resources. These pressures have prompted the enactment of several reforms, which are reviewed. We draw from the American experience with managed care and managed competition to illustrate possible paths for further reform.

Disparidades entre inmigrantes y nativos en el impacto de las condiciones laborales en la salud

OBJECTIVE To examine the contribution of working conditions to permanent disability status in the immigrant and native-born populations in Spain by investigating the extent to which these two groups differ in terms of exposure to adverse working conditions and the impact of these conditions on disability status. METHODS We used a dataset containing ample information on working lives and disability status and specified three probit models that estimated the following: 1) the extent to which working conditions affect the probability of suffering permanent disability, calculated separately for immigrants and natives; 2) whether immigrants, in particular those from non-European Union-15 countries, have a higher probability of exposure to jobs with a greater rate of illness and injury risk; and 3) whether immigrants have a greater probability of being employed in jobs that concentrate three characteristics we consider to have adverse effects on health. RESULTS Working conditions (such as illness and injury risk, lack of autonomy, and temporary jobs) have a significant impact on health in both groups, although the effect is higher for Spanish-born workers. Immigrants, particularly non-European Union immigrants, are more likely to be employed in jobs with adverse health conditions. CONCLUSIONS Working conditions have a strong effect on health, similar to that of other variables, such as education. While immigrants are less likely to suffer disability than native-born workers, these differences are diluted the longer they stay in Spain. A labor market that relegates immigrants to the riskier jobs can be expected to translate into future health inequalities.

El espacio de los seguros privados en los sistemas sanitarios públicos: marco conceptual y políticas

La composicion del sistema sanitario, y en concreto el volumen y la forma de participacion del sector publico y el sector privado dentro del mismo, no es un tema cerrado. El trabajo realiza una puesta al dia de los argumentos que justifican la intervencion publica en sanidad, destacando en especial los fallos del mercado de seguros privados que aconsejan el aseguramiento universal obligatorio, pero haciendo hincapie en que ello no significa que el asegurador tenga que ser necesariamente el propio Estado. Asimismo, se analizan las relaciones entre ambos sectores y las variables que determinan los niveles de gasto relativo en uno y otro sector. Siguiendo la bibliografia sobre provision publica de bienes privados, se observa que en democracia dichos niveles vienen dados por las preferencias del votante medio, para quien el seguro privado suele actuar como complementario del seguro publico. La diferencia de calidad entre los dos sectores, entendida esta no estrictamente como calidad objetiva, es la variable clave que empuja a algunos individuos a comprar seguro privado adicionalmente al seguro publico. Finalmente, en el plano de las politicas, se concluye que la eficacia de las medidas de desgravacion fiscal para el fomento de la compra de seguro sanitario privado no esta firmemente establecida, y se argumenta que los modelos donde los seguros publico y privado estan totalmente separados o totalmente integrados son preferibles a los modelos intermedios, en los que ambos sectores aparecen combinados. La compra de servicios a cambio de un pago capitativo realizada por un agente informado parece mejor formula para la integracion de ambos sectores que el sistema de vales.

Disparities in the effect of working conditions on health between immigrant and native-born populations in Spain

OBJECTIVE To examine the contribution of working conditions to permanent disability status in the immigrant and native-born populations in Spain by investigating the extent to which these two groups differ in terms of exposure to adverse working conditions and the impact of these conditions on disability status. METHODS We used a dataset containing ample information on working lives and disability status and specified three probit models that estimated the following: 1) the extent to which working conditions affect the probability of suffering permanent disability, calculated separately for immigrants and natives; 2) whether immigrants, in particular those from non-European Union-15 countries, have a higher probability of exposure to jobs with a greater rate of illness and injury risk; and 3) whether immigrants have a greater probability of being employed in jobs that concentrate three characteristics we consider to have adverse effects on health. RESULTS Working conditions (such as illness and injury risk, lack of autonomy, and temporary jobs) have a significant impact on health in both groups, although the effect is higher for Spanish-born workers. Immigrants, particularly non-European Union immigrants, are more likely to be employed in jobs with adverse health conditions. CONCLUSIONS Working conditions have a strong effect on health, similar to that of other variables, such as education. While immigrants are less likely to suffer disability than native-born workers, these differences are diluted the longer they stay in Spain. A labor market that relegates immigrants to the riskier jobs can be expected to translate into future health inequalities.