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.
authors.affiliation: State University of New York, Downstate Medical Center, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gusmano
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisz
authors.forename: Victor G
authors.initials: VG
authors.lastname: Rodwin
mesh_terms: D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D008131:London; D016462:Mammaplasty / Q000706:statistics & numerical data; D009026:Mortality; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009519:New York City; D010297:Paris; D011320:Primary Health Care / Q000706:statistics & numerical data; D018855:Single-Payer System; D014505:Urban Population