Achieving horizontal equity

Must we have a single-payer health system?

Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)617-633
Number of pages17
JournalJournal of Health Politics, Policy and Law
Volume34
Issue number4
DOIs
StatePublished - Aug 2009

Fingerprint

Single-Payer System
Primary Health Care
Universal Coverage
Delivery of Health Care
Health Services Accessibility
Aptitude
Insurance Coverage
Health
National Health Programs
Paris
Health Insurance
Health Services

ASJC Scopus subject areas

  • Health Policy

Cite this

Achieving horizontal equity : Must we have a single-payer health system? / Gusmano, Michael K.; Weisz, Daniel; Rodwin, Victor G.

In: Journal of Health Politics, Policy and Law, Vol. 34, No. 4, 08.2009, p. 617-633.

Research output: Contribution to journalArticle

@article{82250d171c0f4fcb9ba51735aa3f85b3,
title = "Achieving horizontal equity: Must we have a single-payer health system?",
abstract = "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.",
author = "Gusmano, {Michael K.} and Daniel Weisz and Rodwin, {Victor G.}",
year = "2009",
month = "8",
doi = "10.1215/03616878-2009-018",
language = "English (US)",
volume = "34",
pages = "617--633",
journal = "Journal of Health Politics, Policy and Law",
issn = "0361-6878",
publisher = "Duke University Press",
number = "4",

}

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.

UR - http://www.scopus.com/inward/record.url?scp=68049087763&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68049087763&partnerID=8YFLogxK

U2 - 10.1215/03616878-2009-018

DO - 10.1215/03616878-2009-018

M3 - Article

VL - 34

SP - 617

EP - 633

JO - Journal of Health Politics, Policy and Law

JF - Journal of Health Politics, Policy and Law

SN - 0361-6878

IS - 4

ER -