Składka zdrowotna jako procent dochodu a solidaryzm: założenia i doświadczenia
Health Insurance Based on Payroll Tax and the Solidarity Principle: Assumptions and Experience

Summary/Abstract: In the health care model prevailing in Poland and Germany, the health insurance fee, withdrawn as percent of the income earned (payroll tax), is treated as the basic tool for the implementation of the principle of social solidarity in the health domain. In practice, the use of this instrument does not guarantee equal access of all the citizens to public health services, nor does it divide fairly the financial burden connected with them, in accordance with the payment abilities of individual households and persons. Many deviations from the solidarity principle may be found in the German system of health insurance, which excludes many social groups from the participation in financing of the public health care. Cumulation of such exemptions can even lead to a reversed income redistribution, with lower insurance burden imposed on rich households. Similar exclusions and examples of inverse redistribution can be found in the health care system existing in Poland. Moreover, insurance fee based on income makes financing of the health care dependent on current economic activity, encouraging substitution of regular work contracts by non-taxed working arrangements (illegal, non-registered jobs and “junk work” agreements), and it does not assure financial stability of the health care system in the ageing society. The author maintains that the universal health care system should be freed from the tasks related to income redistribution, and its financing should be based on equal per capita contribution paid by all citizens.

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