Abstract
The minute advances of health policy in the developing countries and the cost explosion which has hit the health services in the industrialized countries have created an urgent problem. The main culprit is often thought to be the “common-burden principle” which most states apply to the financing of their health services. Possible alternatives are the “user principle” which is more in line with market methods and the “originator principle” which is known from its use in the environmental sphere and is now also being discussed in the health sector. It could be applied to products which are injurious to health (cigarettes, sweets) and harmful production processes (piece-work, water pollution). The author examines the possibilities of curbing health-care spending and drawing nearer to health-policy aims by turning away from the “common burden principle”.
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References
For details of. Public Expenditure on Health, OECD Studies in Resource Allocation, No. 4, Paris 1977, p. 94 ff.
For details of. Financing of health Services, Report of a World Health Organization Study Group, Geneva 1978, p. 115.
Ibid. For details cf. Financing of health services, Report of a World Health Organization Study Group, Geneva 1978, p. 115. Cf. also J. Penkava: Financing Health Care in Eastern Europe, in: V. Halberstadt, A. J. Culyer (ed.): Public Economics and Human Resources, Paris 1975, p. 203 ff. A detailed survey of the mixed financing system in Colombia is provided by M. Selowsky: Who Benefits from Government Expenditure?—A Case Study of Colombia, Washington D. C., 1979, p. 77 ff.
S. Y. Wu, M. A. Zaidi: The Cost Spiral in Health Care, in: economic impact, No. 24 (1978/4), p. 42.
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A few publications only can be mentioned here: A. Maynard: Medical Care and the Price Mechanism, in: K. Judge (ed.): Pricing the Social Services, London and Basingstoke 1980, p. 86 ff.; W. Schönbäck: Markt versus Staat im Gesundheitswesen (Market versus state in the health services), in: W. Schönbäck (ed.): Gesundheit im gesellschaftlichen Konflikt (Health in the social conflict), Munich-Vienna-Baltimore 1980, p. 295 ff.; K.-D. Henke: Selbstbeteiligung als Kostenbremse? (Self-participation as a brake on costs?), in: WIRTSCHAFTSDIENST 1976/V, p. 236 ff.; J. A. Cairns, M. C. Snell: Prices and the Demand for Care, in: A. J. Culyer, K. G. Wright (ed.): Economic Aspects of Health Services, London 1978, p. 95 ff.
Subjective uncertainties are listed by W. Schönbäck: Markt versus Staat ..., ibid. in Gesundheitswesen (Market versus state in the health services), in: W. Schönbäck (ed.): Gesundheit im gesellschaftlichen Konflikt (Health in the social conflict), Munich-Vienna-Baltimore 1980, p. 295.
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According to F. Nashold, advanced capitalism has an innate tendency to expose the substantive prerequisites of the production of goods including in particular the reproduction of labour, to risks, cf.: Strukturelle Bestimmungsfaktoren für die Kostenexplosion im Gesundheitswesen (Structural determinants of the cost explosion in the health services), in: A. Murswieck (ed.): Politik im Sozialsektor, Munich 1976, p. 132 f.
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cf.: Zur Problematik negativer externer Effekte—Verursacher- versus Gemeinlastprinzip? (On the problematic nature of negative external effects—originator principle versus common-burden principle?), in: Zeitschrift für Wirtschafts- und Sozialwissenschaften, No. 3/1977, p. 254 ff. M. Pfaff, A. B. Pfaff on the other hand assume that the incidence is if anything regressive because “the poor spend a higher proportion of their income on goods” the prices of which are increased by environmental costs financed by those who originate them; cf.: Auswirkungen der Umweltverscmutzungen und Umweltschutzpolitik (Effects of pollution and anti-pollution policies), in: B. Külp, H.-D. Haas (ed.): Soziale Probleme der modernen Industriegesellschaft, Berlin 1977, p. 188 f.
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For the OECD area cf.: OECD Environment Committee, Group of Experts: Employment Effects of Environmental Policies, Paris 1976; and for the Federal Republic of Germany: W. Meißner, E. Hödl: Auswirkungen der Umweltpolitik auf den Arbeismarkt (Effects of the environmental policy on the labour market), Bonn 1978, and R. Sprenger: Beschäftigungseffekte der Umweltpolitik (Employment effects of environmental policy), Munich 1979.
K.-H. Hansmeyer: Finanzpolitische Aspekte der Umweltpolitik: Verursacherprinzip, Gemeinlastprinzip, Abwasserabgabe (Financial aspects of the environmental policy: The originator principle, the common-burden principle, the waste-water levy), in: Das Wirtschaftsstudium, No. 8/1977, p. 373.
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Huppertz, PH. Alternative principles of financing health care. Intereconomics 15, 252–257 (1980). https://doi.org/10.1007/BF02924582
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DOI: https://doi.org/10.1007/BF02924582