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The European Journal of Health Economics

, Volume 19, Issue 2, pp 293–307 | Cite as

Do healthcare tax credits help poor-health individuals on low incomes?

  • Cinzia Di Novi
  • Anna Marenzi
  • Dino Rizzi
Original Paper

Abstract

In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditure. Tax credits benefit taxpayers at all income levels by reducing their net tax liability and modify the price of out-of-pocket expenditure. To the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These effects influence, in turn, income distributions and taxpayers’ health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated. However, little is known about the ability of tax credits to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on income-related inequality in health status with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model that reproduces the personal income tax and incorporates taxpayers’ behavioral responses to changes in tax credit rate. Our results suggest that the current healthcare tax credit design tends to favor the richest part of the population.

Keywords

Personal income tax Health-related tax credit Health inequality 

JEL Classification

I10 I14 H24 

Notes

Acknowledgements

An earlier draft of this paper was presented at the annual meeting of the Italian Public Economic Associations, Lecce, Italy, and at the annual meeting of the Italian Health Economics Association, Bologna, Italy. The authors wish to thank the conference participants for their detailed and helpful comments. The authors in particular wish to thank Andrea Albarea for his assistance in gathering and processing the data. The paper benefitted from comments from Michele Bernasconi, Enrica Croda, Gianmaria Martini and Francesca Zantomio. The usual disclaimer applies.

Supplementary material

10198_2017_884_MOESM1_ESM.doc (179 kb)
Supplementary material 1 (DOC 179 kb)

References

  1. 1.
    Albarea, A., Bernasconi, M., Di Novi, C., Marenzi, A., Rizzi, D., Zantomio, F.: Accounting for tax evasion profiles and tax expenditures in microsimulation modelling. The BETAMOD model for personal income taxes in Italy. Int. J. Microsimul. 8, 99–136 (2015)Google Scholar
  2. 2.
    Atella, V., Borgonovi, E., Collicelli, C., Kopinska, J., Lecci, F., Maietta, F.: Crisi economica, diseguaglianze nell’accesso ai servizi sanitari ed effetti sulla salute delle persone in Italia. I Quaderni della Fondazione Farmafactoring, No. 01.2015, (2015)Google Scholar
  3. 3.
    Bago d’Uva, T.E., Van Doorslaer, Lindeboom, M., Lindeboom, O.: Does reporting heterogeneity bias the measurement of health disparities? Health Econ. 17, 351–375 (2008)CrossRefPubMedGoogle Scholar
  4. 4.
    Baker, M., Stabile, M., Deri, C.: What do self-reported, objective, measures of health measure? J. Human Resour. 4, 1067–1093 (2004)CrossRefGoogle Scholar
  5. 5.
    Balestra, C., Sultan, J.: Home sweet home: the determinants of residential satisfaction and its relation with well-being. OECD Statistics Directorate Working Papers, No. 5, (2013)Google Scholar
  6. 6.
    Balia, S., Jones, A.M.: Mortality, lifestyle and socio-economic status. J. Health Econ. 27, 1–26 (2008)CrossRefPubMedGoogle Scholar
  7. 7.
    Benzeval, M., Judge, K., Whitehead, M.: Tackling inequalities in health: an agenda for action. King’s Fund, London (1995)Google Scholar
  8. 8.
    Besley, T., Hall, J., Preston, I.: The demand for private health insurance: do waiting lists matter? J. Publ. Econ. 72, 155–181 (1999)CrossRefGoogle Scholar
  9. 9.
    Burman, L.E.: Is the tax expenditures concept still relevant? Natl. Tax J. LVI, 613–627 (2003)CrossRefGoogle Scholar
  10. 10.
    Burman, L.E., Toder, E., Geissler, C.: How big are total individual income tax expenditures, and who benefits from them? Am. Econ. Rev. 98, 79–83 (2008)CrossRefGoogle Scholar
  11. 11.
    Cavalieri, M.: Geographical variation of unmet medical needs in Italy: a multivariate logistic regression analysis. Int. J. Health Geograph. 12, 27 (2013)CrossRefGoogle Scholar
  12. 12.
    Contoyannis, P., Jones, A.M.: Socio-economic status, health and lifestyle. J. Health Econ. 23, 965–995 (2004)CrossRefPubMedGoogle Scholar
  13. 13.
    Contoyannis, P., Jones, A.M., Rice, N.: The dynamics of health in the British Household Panel Survey. J. Appl. Econ. 19, 473–503 (2004)CrossRefGoogle Scholar
  14. 14.
    Costa-Font, J., Hernandez-Quevedo, C., Jimenez-Rubio, D.: Income inequalities in unhealthy life styles in England and Spain. Econ. Human Biol. 13, 66–75 (2014)CrossRefGoogle Scholar
  15. 15.
    Crivelli, L., Salari, P.: The inequity of the Swiss health care system financing from a federal state perspective. Int. J. Equity Health 13, 1–13 (2014)CrossRefGoogle Scholar
  16. 16.
    de Belvis, A.G., Ferrè, F., Specchia, M.L., Valerio, L., Fattore, G., Ricciardi, W.: The financial crisis in Italy: implications for the healthcare sector. Health Policy 10, 10–16 (2012)CrossRefGoogle Scholar
  17. 17.
    Deaton, A.: Health, inequality, and economic development. J. Econ. Lit. 41, 113–158 (2003)CrossRefGoogle Scholar
  18. 18.
    Di Novi, C.: The Influence of traffic-related pollution on individuals’ life-style: results from the BRFSS. Health Econ. 19, 1318–1344 (2010)CrossRefPubMedGoogle Scholar
  19. 19.
    Dirindin, N.: Chi paga per la salute degli italiani?. Il Mulino, Bologna (1996)Google Scholar
  20. 20.
    Dixon, H., Siciliani, L.: Waiting-time targets in the healthcare sector: how long are we waiting? J. Health Econ. 28, 1081–1098 (2009)CrossRefPubMedGoogle Scholar
  21. 21.
    Erreygers, G.: Correcting the concentration index. J. Health Econ. 28, 504–515 (2009)CrossRefPubMedGoogle Scholar
  22. 22.
    Fattore, G., Mariotti, G., Rebba, V.: Review of waiting times policies: country case studies, Italy. In: Siciliani, L., Borowitz, M., Moran, V. (eds.) Waiting time policies in the health sector—what works?, Chapter 9, OECD Health Policy Studies (2013)Google Scholar
  23. 23.
    France, G., Taroni, F., Donatini, A.: The Italian health-care system. Health Econ. 14, 187–202 (2005)CrossRefGoogle Scholar
  24. 24.
    Getzen, T.: Health care is an individual necessity and a national luxury: applying multilevel decision models to the analysis of health care expenditures. J. Health Econ. 19, 259–270 (2000)CrossRefPubMedGoogle Scholar
  25. 25.
    Grossman, M.: On the concept of health capital and the demand for health. J. Polit. Econ. 80, 223–255 (1972)CrossRefGoogle Scholar
  26. 26.
    Heckman, J.J.: Sample selection bias as a specification error. Econometrica 47, 153–161 (1979)CrossRefGoogle Scholar
  27. 27.
    Idler, E.L., Benyamini, Y.: Self-rated health and mortality: a review of twenty-seven community studies. J. Health Soc. Behav. 38, 21–37 (1997)CrossRefPubMedGoogle Scholar
  28. 28.
    ISTAT: Le differenze nel livello dei prezzi al consumo tra i capoluoghi delle regioni italiane. (http://www.istat.it/it/archivio/6279) (2010)
  29. 29.
    ISTAT: Health for all. (http://www.istat.it/it/archivio/14562) (2015)
  30. 30.
    Jakobsson, U.: On the measurement of the degree of progression. J. Public Econ. 5, 161–168 (1976)CrossRefGoogle Scholar
  31. 31.
    Kaplow, L.: The income tax as insurance: the casualty loss and medical expense deductions and the exclusion of the medical insurance premiums. NBER Working Paper, No. 3723, (1991)Google Scholar
  32. 32.
    Kenkel, D.S.: The demand for preventive medical care. Appl. Econ. 26, 313–325 (1994)CrossRefGoogle Scholar
  33. 33.
    Kennedy, B.P., Kawachi, I., Glass, R., Prothrow-Stith, D.: Income distribution, socio-economic status, and self-rated health in the United States: multilevel analysis. Br. Med. J. 317, 917–921 (1998)CrossRefGoogle Scholar
  34. 34.
    Kohn, J.L.: What is health? A multiple correspondence health index. East. Econ. J. 38, 223–250 (2012)CrossRefGoogle Scholar
  35. 35.
    Liu, S., Chollet, D.: Price and income elasticity of the demand for health insurance and health care services: a critical review of the literature. http://www.mathematica-mpr.com/publications/pdfs/priceincome.pdf (2006)
  36. 36.
    Mackenbach, J.: The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc. Sci. Med. 75, 761–769 (2012)CrossRefPubMedGoogle Scholar
  37. 37.
    Ministry of Economy and Finance: (http://www.dt.tesoro.it/en) (2010 and 2015)
  38. 38.
    Newhouse, J.P., Phelps, C.E.: Price and income elasticities of the demand for medical care services. In: Perlman, M. (ed.) The economics of health and medical care, pp. 139–161. Macmillan, London (1974)CrossRefGoogle Scholar
  39. 39.
    O’Donnell, O., van Doorslaer, E., Wagstaff, A., Lindelow, M.: Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank Publications, No. 434, Washington (2008)Google Scholar
  40. 40.
    OECD, Health Statistics: FOCUS on health spending. Available at http://www.oecd.org/els/health-systems/health-data.htm (2015)
  41. 41.
    Prasad, N.: Policies for redistribution: the use of taxes and social transfers. International Institute for Labour Studies Discussion Paper, No. 194 (2008)Google Scholar
  42. 42.
    Poterba, J.M.: Economic analysis of tax expenditures. Natl. Tax J. 64, 451–458 (2011)CrossRefGoogle Scholar
  43. 43.
    Ramalho, E.A., Ramalho, J.J.S., Enriques, P.D.: Fractional regression models for second stage DEA efficiency analyses. J. Prod. Anal. 34, 239–255 (2010)CrossRefGoogle Scholar
  44. 44.
    Smart, M., Stabile, M.: Tax credits, insurance, and the use of medical care. Can. J. Econ. 38, 345–365 (2005)CrossRefGoogle Scholar
  45. 45.
    Tyson, J.: Reforming tax expenditures in Italy: what, why, and how?. IMF Working Paper, January 2014 (2014)Google Scholar
  46. 46.
    Toder, E., Harris, B.H., Lim, K.: Distributional effects of tax expenditures in the United States. In: Philipps, L., Brooks, N., Li, J. (eds.) Tax expenditures: state of the art. Canadian Tax Foundation, Toronto (2011)Google Scholar
  47. 47.
    Toder, E., Baneman, D.: Distributional effects of individual income tax expenditures: an update. Urban-Brookings Tax Policy Center, February 2 (2012)Google Scholar
  48. 48.
    Undén, A.L., Elofsson, S.: Do different factors explain self-rated health in men and women? Gend. Med. 3, 295–308 (2006)CrossRefPubMedGoogle Scholar
  49. 49.
    Vyas, S., Kumaranayake, L.: Constructing socioeconomic status indices: how to use principal components analysis. Adv. Access Publ. 9, 459–468 (2006)Google Scholar
  50. 50.
    Wagstaff, A.: The demand for health theory and applications. J. Epidemiol. Community Health 40, l–11 (1986)CrossRefGoogle Scholar
  51. 51.
    Wagstaff, A., van Doorslear, E., Paci, P.: On the measurement of horizontal inequity in the delivery of health care. J. Health Econ. 10, 169–205 (1991)CrossRefPubMedGoogle Scholar
  52. 52.
    Wagstaff, A., van Doorslaer, E.: Measuring and testing for inequity in the delivery of health care. J. Human Resour. 35, 716–733 (2000)CrossRefGoogle Scholar
  53. 53.
    Wagstaff, A., van Doorslaer, E.: What makes the personal income tax progressive? A comparative analysis for fifteen OECD countries. Int. Tax Publ. Finance 8, 299–315 (2001)CrossRefGoogle Scholar
  54. 54.
    Wilkinson, R.G., Pickett, K.E.: Income inequality and population health: a review and explanation of the evidence. Soc. Sci. Med. 62, 1768–1784 (2006)CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Economics and ManagementUniversity of PaviaPaviaItaly
  2. 2.Department of EconomicsCa’ Foscari University of VeniceVeniceItaly
  3. 3.Health, Econometrics and Data GroupUniversity of YorkYorkUK
  4. 4.LCSR, National Research University Higher School of EconomicsMoscowRussian Federation

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