Handling the High Spenders: Implications of the Distribution of Health Expenditures for Financing Health Care (original) (raw)
2009, Health Care Delivery & Financing eJournal
Health financing policy involves determining how to distribute the costs of illness. Several paradigms contend. As Stone noted, one is the struggle between two visions of distributive justice - the solidarity principle which seeks to distribute these costs on the basis of ability to pay, vs. views based on actuarial fairness which seek to distribute these costs on the basis of the likelihood of incurring them. A related debate is whether health is a consumer good or a merit good, linked to questions about what should happen to those unable to pay for care. In the US, dialogue has tended to emphasize consumer sovereignty and suggest the risk of moral hazard should insurance coverage be too generous. In Canada, dialogue has stressed health care as a mutual responsibility, tempered by ongoing fears that overly generous coverage threatens the sustainability of the system. Our analysis of data related to the distribution of health expenditures, however, suggests that moral hazard is vast...
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