Michael Gerfin

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 delivery of health care in Europe and the US

This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.

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.

The redistributive effect of Health Care Finance in twelve OECD countries

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.

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.

Parametric and semi‐parametric estimation of the binary response model of labour market participation

This paper compares the familiar probit model with three semiparametric estimators of binary response models in an application to labour market participation of married women. This exercise is performed using two different cross-section data sets from Switzerland and Germany. For the Swiss data the probit specification cannot be rejected and the models yield similar results. In the German case the probit model is rejected, but the coefficient estimates do not vary substantially across the models. The predicted choice probabilities, however, differ systematically for a subset of the sample. The results of this paper indicate that more work is necessary on specification tests of semiparametric models and on simulations using these models. Copyright 1996 by John Wiley & Sons, Ltd.

The Effects of Immigration on Wages: An Application of the Structural Skill-Cell Approach

SummaryThis paper investigates how recent immigration inflows from 2002 to 2008 have affected wages in Switzerland. This period is of particular interest as it marks the time during which the bilateral agreement with the EU on the free cross-border movement of workers has been effective. Since different types of workers are likely to be unevenly affected by recent immigration inflows, we follow the “structural skill-cell approach” as for example employed by Borjas (2003) and Ottaviano and Peri (2008). This paper provides two main contributions. First, we estimate empirically the elasticities of substitution between different types of workers in Switzerland. Our results suggest that natives and immigrants are imperfect substitutes. Regarding different skill levels, the estimates indicate that workers are imperfect substitutes across broad education groups and across different experience groups. Second, the estimated elasticities of substitution are used to simulate the impact on domestic wages using the actual immigration inflows from 2002 to 2008. For the long run, the simulations produce some notable distributional consequences across different types of workers: While previous immigrants incur wage losses (−1.6%), native workers are not negatively affected on average (+0.4%). In the short run, immigration has a negative macroeconomic effect on the average wage, which, however, gradually dies out in the process of capital adjustment.

A simultaneous discrete choice model of labor supply and wages for married women in Switzerland

A simultaneous model of female labor supply and wages is estimated. The labor supply model is formulated as a trichotomous discrete choice model in order to take into account the bimodal distribution of observed working hours. For women without observed wages the probability of choosing the observed work category is integrated over all values of the wage. The model is estimated using a sample of married women in Switzerland. The budget constraint is constructed by computing the disposable income for each hours point, taking into account the Swiss income tax system.The estimation results imply relatively modest wage elasticities of expected labor supply for working women. On the other hand the elasticity of the participation probability with respect to wages for nonworkers is twice as large. The magnitude of the income elasticities is comparable to other studies. The wage elasticities obtained with two alternative estimation procedures are considerably lower. These results show that wage elasticities crucially depend on how the problem of unobserved wages is solved.

Healthcare Demand in the Presence of Discrete Price Changes

Deductibles in health insurance generate nonlinear budget sets and dynamic incentives. Using detailed individual health expenditure data from a Swiss health insurer, we estimate the response in healthcare demand to the discrete price increase generated by resetting the deductible at the start of each calendar year. We find that for individuals with high deductibles, healthcare demand drops by 27%. The decrease is most pronounced for inpatient care and prescription drugs. By contrast, for individuals with low deductibles, there is no significant change in healthcare demand (except for prescription drugs). Overall our results suggest that healthy individuals respond much stronger to the price change.

Does Full Insurance Increase the Demand for Health Care

We estimate the causal impact of having full health insurance on healthcare expenditures. We take advantage of a unique quasi-experimental setup in which deductibles and co-payments were zero in a managed care plan and nonzero in regular insurance, until a policy change forced all individuals with an active plan to cover a minimum amount of their expenses. Using panel data and a nonlinear difference-in-differences strategy, we find a demand elasticity of about -0.14 comparing full insurance with the cost-sharing model and a significant upward shift in the likelihood to generate costs. Copyright