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Achieving horizontal equity: must we have a single-payer health system?
Michael K Gusmano1, Daniel Weisz, Victor G Rodwin
1State University of New York, Downstate Medical Center, USA.
Journal of Health Politics, Policy and Law
|July 28, 2009
Summary
Single-payer versus multipayer health care systems: this study compares access to care in England, France, and the US. Findings suggest system design, not payer number, impacts equitable health care access.
Area of Science:
- Health Services Research
- Comparative Health Policy
- Health Equity Studies
Background:
- Assessing health care equity requires comparing access across different healthcare system structures.
- Horizontal equity, defined as equal treatment for equal need, is a key metric for evaluating healthcare system performance.
- Existing research often links healthcare system structure to equity, but empirical comparisons are limited.
Purpose of the Study:
- To investigate whether single-payer health care systems provide greater horizontal equity than multipayer systems.
- To compare access to primary and specialty health care services across diverse socioeconomic groups in different healthcare systems.
- To determine if the number of payers in a health care system influences its capacity for equitable access.
Main Methods:
- Comparative analysis of healthcare access in three distinct national systems: English National Health Service (single-payer), French National Health Insurance (multipayer, universal coverage), and the US (multipayer, coverage gaps).
- Neighborhoods were selected and grouped by average household income to assess disparities in access.
- Primary and specialty health care service access was evaluated across these income-stratified neighborhoods.
Main Results:
- Paris residents, irrespective of income, demonstrated better access to health care services compared to residents of Inner London and Manhattan.
- Low-income residents in the French system experienced more equitable access relative to their higher-income counterparts than observed in the English or US systems.
- The study found significant variations in access within the US system, highlighting the impact of insurance coverage gaps.
Conclusions:
- The number of payers in a health care system does not appear to be the primary determinant of equitable access to care.
- Healthcare system design and policies aimed at assuring access to primary and specialty care are more critical for achieving horizontal equity.
- Focusing on system capacity to guarantee access, rather than solely on the number of payers, is crucial for improving health care equity.
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