TY - JOUR
T1 - Achieving horizontal equity
T2 - Must we have a single-payer health system?
AU - Gusmano, Michael K.
AU - Weisz, Daniel
AU - Rodwin, Victor G.
PY - 2009/8
Y1 - 2009/8
N2 - The question posed in this article is whether single-payer health care systems are more likely to provide equal treatment for equal need (horizontal equity) than are multipayer systems. To address this question, we compare access to primary and specialty health care services across selected neighborhoods, grouped by average household income, in a single-payer system (the English NHS), a multiple-payer system with universal coverage (French National Health Insurance), and the U.S. multiple-payer system characterized by large gaps in health insurance coverage. We find that Paris residents, including those with low incomes, have better access to health care than their counterparts in Inner London and Manhattan. This finding casts doubt on the notion that the number of payers influences the capacity of a health care system to provide equitable access to its residents. The lesson is to worry less about the number of payers and more about the system's ability to assure access to primary and specialty care services.
AB - The question posed in this article is whether single-payer health care systems are more likely to provide equal treatment for equal need (horizontal equity) than are multipayer systems. To address this question, we compare access to primary and specialty health care services across selected neighborhoods, grouped by average household income, in a single-payer system (the English NHS), a multiple-payer system with universal coverage (French National Health Insurance), and the U.S. multiple-payer system characterized by large gaps in health insurance coverage. We find that Paris residents, including those with low incomes, have better access to health care than their counterparts in Inner London and Manhattan. This finding casts doubt on the notion that the number of payers influences the capacity of a health care system to provide equitable access to its residents. The lesson is to worry less about the number of payers and more about the system's ability to assure access to primary and specialty care services.
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U2 - 10.1215/03616878-2009-018
DO - 10.1215/03616878-2009-018
M3 - Article
C2 - 19633225
AN - SCOPUS:68049087763
SN - 0361-6878
VL - 34
SP - 617
EP - 633
JO - Journal of health politics, policy and law
JF - Journal of health politics, policy and law
IS - 4
ER -