Horizontal Equity Research Articles

Equity evaluation of intensive care unit admission based on comorbidity in hospitalized patients with COVID-19: a cross-sectional analysis.

Intensive care unit (ICU) beds played a crucial role in reducing mortality rates of patients with severe COVID-19. The surge in the number of patients led to a shortage of ICU beds, which may have exacerbated inequity of healthcare utilization. However, most attention has been focused on the horizontal equity in healthcare utilization, where individuals with the same needs receive the same services. Vertical equity, where individuals with higher needs receive more healthcare is often neglected, which might overestimate the equity. This study analyzes the vertical equity of ICU utilization among hospitalized patients with COVID-19. In total, 18,547 hospitalized patients with COVID-19 in Maryland in 2020 were enrolled in this cross-sectional study. Logistic regression analysis was conducted to determine the independent factors affecting ICU utilization, and the Shapley value decomposition approach was implemented to assess the contribution of the independent variables to disparities in ICU admission. A concentration curve and concentration index were used to assess the vertical equity in healthcare utilization. ICU utilization by patients with COVID-19 was significantly affected by Charlson Comorbidity Index (CCI), with odds ratios (OR) 1.09 [95% confidence intervals (CI): 1.07-1.10; p < 0.001] in univariable analysis and 1.11 (95% CI: 1.09-1.13; p < 0.001) in multivariable regression analysis. The most important contributors were household income (32.27%) and the CCI (22.89%) in the Shapley value decomposition analysis. The concentration curve was below the line of equity, and the concentration index was 0.094 (95% CI: 0.076-0.111; p < 0.001), indicating that ICU utilization was concentrated among patients with a high CCI. These results were robust for all subgroup analyses. Among 18,547 hospitalized patients with COVID-19 in Maryland in 2020, ICU utilization was significantly affected by comorbid conditions. The concentration curve and concentration index also indicated that ICU utilization was more concentrated in patients with a higher CCI. The results was consistent with the principle of vertical equity, whereby healthcare resources are more concentrated on COVID-19 patients with higher health needs.

Costs and resource distribution of direct services for HIV in Uganda

ObjectiveIn high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of...

Horizontal Inequality in Healthcare Utilisation in Rural Sabah, Malaysia

Ensuring universal access to healthcare is essential for societal equity. However, significant inequalities exist within global healthcare systems, resulting in unequal access to services and divergent health outcomes. Socioeconomic inequity, poor living conditions, and inadequate healthcare infrastructure perpetuate poor health among poor communities. Despite greater healthcare needs, economically disadvantaged populations face substantial barriers to obtaining necessary services. This research evaluates the equitable aspect of healthcare utilisation in Sabah’s rural areas to guide policy formulation. Nabawan, a rural area in Sabah with high poverty rates, was selected to assess income-related inequality and inequity in healthcare utilisation. Using the horizontal equity index and decomposition analysis, it was found that economic status significantly influences healthcare distribution, typically favouring the affluent. Central to this analysis is the concept of “equal treatment for equal need,” ensuring individuals with similar healthcare needs receive similar care regardless of economic status. Results indicate that wealthier individuals are slightly more likely to utilise healthcare services, although the difference is minimal. To address disparities, enhancing targeted financial assistance programs like PeKa B40 could reduce out-of-pocket expenses for low-income households. Additionally, increasing healthcare funding for rural infrastructure and training local healthcare workers can ensure equitable access for all households.

Horizontal and Vertical Spatial Equity Analysis Based on Accessibility to Living Service Amenities: A Case Study of Xi’an, China

Accessibility is closely related to residents’ well-being and quality of life and is a potential indicator of social equity. This study aims to present a methodology for assessing the combined equity of living service amenities (LSAs) based on accessibility. This study focuses on fourteen types of LSAs in six dimensions and improves the three-step floating catchment area (3SFCA) model by considering the behavioral demand characteristics of different age groups. Taking the main built-up area of Xi’an as an example, the modified 3SFCA model is applied to assess the accessibility of LSAs, and the supply–demand index is used to measure the supply and demand level of the horizontal dimension. Furthermore, random forest regression was used to screen the key socioeconomic indicators affecting the accessibility of LSAs, and then the binary spatial correlation local index was used to reveal the spatial distribution characteristics between LSA accessibility and key socioeconomic indicators in the vertical dimension. Finally, the comprehensive equity of LSAs is evaluated by space superposition. The results showed that there was a serious imbalance between the supply and demand of LSAs in Xi’an’s main built-up area, with polarized oversupply and weak supply areas, especially for accessibility to low-grade LSAs. Accessibility is relatively low for children and young and middle-aged groups, and intergenerational inequalities were particularly pronounced among them. The lower-income group was generally at a disadvantage in accessing the high-demand amenities, and those who resided in affordable housing in the periphery of the city were more likely to face social exclusion. This study emphasizes the importance of distributing urban resources equitably among different social groups, which can help decision makers achieve a balance between horizontal equity and vertical equity in the allocation of urban LSAs and promote spatial equity and sustainable social development.

Evaluating temporal variations in access to multi-tier hospitals using personal vehicles and public transit: Implications for healthcare equity

Understanding healthcare accessibility, or the ability to access healthcare services, has significant implications for both individual well-being and community equity. However, existing studies seldom account for temporally varying factors such as traffic conditions and hospital schedules, resulting in miscalculation of accessibility. This study addresses this gap by introducing a framework that evaluates accessibility to multi-tier hospitals, factoring in both spatial and temporal aspects, using public transit (PT) and personal vehicles (PVs), and assesses its impact on horizontal and vertical equity. Implemented in Shanghai, China, we employ the Gaussian two-step floating catchment area method for accessibility quantification and utilize map APIs for dynamic travel time data. Our analysis reveals: (i) notable temporal fluctuations in healthcare accessibility, especially for PT, and their significant impact on both horizontal and vertical equity due to varying travel times and hospital schedules; (ii) larger disparities in higher-tier hospital accessibility compared to lower-tier ones; (iii) greater horizontal equity using PV-based accessibility and higher vertical equity using PT-based accessibility. These findings highlight the need to offer customized transit to healthcare facilities, expand telehealth services, incorporate equity in healthcare resource allocation, incentivize healthcare professionals to work in underserved areas, and develop outreach programs to improve accessibility and equity.

Three Pillars of Support for Orphan Drug Programs: Individual Valuations, Societal Valuations, and Anonymous Altruism

ObjectivesTo identify and describe potential societal and individual sources of support for orphan drug programs. MethodsThe Generalized Risk-Adjusted Cost-Effectiveness method shows that acute illness and disability severity increase individuals’ willingness to pay for health gains. We develop a social welfare function (SWF) that incorporates individuals’ own values, combined with politically or ethically determined weights. We introduce the concept of horizontal equity—that individuals in similar situations should be treated similarly—into the SWF. Finally, we introduce anonymous altruism into individuals’ utility functions—the desire to help others, without knowing their identity. ResultsCombined with the empirical link between disease severity and rarity, the Generalized Risk-Adjusted Cost-Effectiveness method demonstrates heightened willingness to pay for health gains for people with rare diseases, leading rational individuals to support orphan drug programs, our first pillar of support. Adding horizontal equity to the SWF further increases societal support for orphan drug programs. Anonymous altruism, focusing most strongly on those in the most-dire circumstances, leads to altruistic support for those with severe disorders. Because innovators’ economic incentives lead them to focus on larger markets, anonymous altruistic individuals will increasingly prefer public investments into rare diseases over time, as private markets systematically produce gains for common diseases. ConclusionsWe identified 3 supporting pillars for orphan drug programs: (1) individuals’ propensity to prefer treatments for severe diseases; (2) the preference for horizontal equity in our social welfare; (3) anonymous altruism, the desire to help strangers, coupled with market incentives that underserve strangers with rare diseases.

부동산 공시가격 현실화 정책에 따른 재산세부담의 변화 분석

This study focused on the impact of the policy of realizing published prices of real estate on real estate property taxes and estimated the property tax burden using real estate price announcement data for land, single-family house, and apartment from 2017 to 2020. In addition, the changes in tax burden by year were analyzed and compared by real estate type, price level, and region to discuss the impact of the published price realization policy and suggest policy implications. According to the analysis of changes in the estimated property tax burden, the property tax burden increased significantly after the realization policy, and the gap in the property tax burden by region and price level widened. And the tax burden increased intensively on specific real estate types and high-priced real estate. This suggests that the policy of applying the realization of the published price differently by price range can rather hinder vertical and horizontal equity of taxation among taxpayers.

Digital Infrastructure Construction and Improvement of Non-Farm Employment Quality of Rural Labor Force—From the Perspective of Informal Employment

The pivotal role of digital infrastructure as hardware support for fostering economic efficiency in the digital economy is widely acknowledged. However, it begs the question, can the development of digital infrastructure also advance social equity, particularly concerning horizontal equity, as exemplified by the quality of non-farm employment among rural laborers, which serves as a barometer for the fairness and inclusivity of the social opportunity landscape? This article delves into the ramifications of digital infrastructure development on the quality of non-farm employment for rural laborers. Initially, it conducts a theoretical exploration of the impact and mechanisms of digital infrastructure construction on non-farm employment quality within rural labor sectors, drawing upon the Todaro model framework and existing scholarly discourse. Subsequently, by integrating data on digital infrastructure construction at the prefecture-level city level with four periods of the China Family Panel Studies (CFPS) data spanning 2014 to 2020, employing various endogenous treatment methods including two-way fixed effects, sensitivity analysis, and instrumental variable techniques, it empirically tests and analyzes the internal mechanisms. The findings reveal that digital infrastructure construction plays a beneficial role in enhancing the quality of non-farm employment for rural laborers, encompassing both subjective perceptions and objective circumstances of non-farm work. Notably, it is observed that digital infrastructure construction significantly fosters improvements in the quality of informal employment among rural laborers, with notable disparities across gender and skill levels. This discovery exerts a positive influence on advancing the sustainable development of the labor market. Specifically, female rural laborers necessitate higher skill proficiency and educational attainment to attain commensurate benefits as their male counterparts. Moreover, caution is warranted regarding the potential for digital infrastructure construction to exacerbate existing power differentials and widen socioeconomic disparities through the perpetuation of the digital divide.

Does high-speed railway promote horizontal equity within and between cities? Evidence from China

The ongoing debate regarding the impact of rail infrastructures on equity has been a subject of continued interest, particularly in light of increased investments in transportation infrastructures. While numerous studies have explored the distributional impact of high-speed railway (HSR) on intercity economic disparity and accessibility changes, there’s less focus on equity within the city. Consequently, this study employs the difference-in-difference model to analyze the impact of HSR on equity within the city using prefecture-level data in China spanning 2006–2019. Additionally, the study examines the equity between cities, using the Wuhan-Guangzhou railway line as a case study. The findings reveal that the introduction of HSR not only directly enhances equity between cities by improving job accessibility but also indirectly diminishes the urban-rural divide by creating more job opportunities for rural residents. This study broadens the concept of horizontal equity by considering equity within the city and expands the investigation on the equity between cities from traditional accessibility studies to more focused job accessibility. Furthermore, the study contributes to understanding the equity impact of remittance behavior from rural-to-urban migrant workers on balancing urban-rural development, a phenomenon characterized by the quick urbanization of China and also popular in developing countries around the world.

Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy

BackgroundWhen today’s efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden’s long and ongoing journey towards universal health coverage and equal access to healthcare.MethodsThe focus is on macro-level policy. A document analysis is divided into three broad eras (1919–1955; 1955–1989; 1989–) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need.ResultsOver the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system’s Achilles’ heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services.Conclusions: brief summary and potential implicationsIt can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden’s welfare ‘exceptionalism’, or is a temporary decline remains to be assessed in the future.

Horizontal and vertical equity and public subsidies for private health insurance in the U.S.

The United States offers two markedly different subsidy structures for private health insurance. When covered through employer-based plans, employees and their dependents benefit from the exclusion from taxable income of the premiums. Individuals without access to employer coverage may obtain subsidies for Marketplace coverage. This paper seeks to understand how the public subsidies embedded in the privately financed portion of the U.S. healthcare system impact the payments families are required to make under both ESI and Marketplace coverage, and the implications for finance equity.Using the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) and Marketplace premium data, we assess horizontal and vertical equity by calculating public subsidies for and expected family spending under each coverage source and using Lorenz curves and Gini and concentration coefficients. Our study pooled the 2018 and 2019 MEPS-HC to achieve a sample size of 10,593 observations. Our simulations showed a marked horizontal inequity for lower-income families with access to employer coverage who cannot obtain Marketplace subsidies. Relative to both the financing of employer coverage and earlier Marketplace tax credits, the more generous Marketplace premium subsidies, first made available in 2021 under the American Rescue Plan Act, substantially increased the vertical equity of Marketplace financing. While Marketplace subsidies have clearly improved equity within the United States, we conclude with a comparison to other OECD countries highlighting the persistence of inequities in the U.S. stemming from its noteworthy reliance on employer-based private health insurance.

Trade-offs Between Equity and Efficiency in Prioritizing Critical Infrastructure Investments: A Case of Stormwater Management Systems

Critical infrastructures in many countries face the problem of aging and, thus, require significant upgrades to continue serving their purpose for the next few decades, especially in the face of extreme weather events caused by global climate change. Given the urgent need for such improvements and the substantial funding gaps being experienced, prioritizing investments in critical infrastructures is a challenging task for governments. Furthermore, the need to assure equitable solutions, as well as to consider deep uncertainty due to climate change, adds to the complexity of the problem. We seek to address this complexity by developing a set of models that explicitly consider both horizontal and vertical equity, along with efficiency, in prioritizing stormwater infrastructure improvement projects. While horizontal equity seeks to provide equal resources to everyone, vertical equity aims to allocate relatively more resources to vulnerable groups who are disproportionately susceptible to shocks and are more likely to fall into chronic poverty. By differentiating between losses in horizontal equity and vertical equity due to efficiency considerations, the models provide a practical approach to find the right balance among efficiency, horizontal equity, and vertical equity. The initial models are then extended into regret-based optimization models to help address the issue of deep uncertainty. A case study of stormwater infrastructure improvement in the City of Miami is presented, through which the performance of the models is explored both with and without the projected sea-level rise scenarios. The findings highlight the value of the proposed approach in promoting equity while maintaining efficiency.

Spatial equity of urban parks from the perspective of recreational opportunities and recreational environment quality: A case study in Singapore

Spatial equity in urban park recreational services can significantly contribute to sustainable urban planning. However, there are shortcomings in research comparing the spatial equity of different categories of parks and urban parks overall from the perspective of recreational opportunities and recreational environment quality available to residents across various neighborhoods. In this paper, emphasizing park access within a 10-minute walk, we proposed an evaluation system at the neighborhood level for regional parks, community parks, and urban parks overall (regional and community parks combined) from this under-researched perspective. Taking Singapore as a case study, the feasibility of this evaluation system has been verified. We applied Lorenz curve, Gini coefficient, locational entropy, and spatial autocorrelation analysis to compare the differences of horizontal spatial equity and spatial distribution patterns of different categories of parks and urban parks overall from the perspective of recreational opportunities and recreational environment quality. Results showed that the horizontal spatial inequity of recreational opportunities is higher than that of recreational environment quality with respect to regional parks, community parks, and urban parks overall. Compared with regional parks, community parks have a greater effect on improving the horizontal spatial equity of recreational opportunities and recreational environment quality of urban parks overall. Park recreational opportunities and recreational environment quality available to residents in each neighborhood have significant spatial accumulation patterns. The evaluation system and its application enable a more comprehensive assessment of the spatial distribution of neighborhood-level park recreational opportunities and recreational environment quality.

Examining the impact of bicycle-oriented multimodality on accessibility and transport equity in the metropolitan area of Athens, Greece

ABSTRACT Bicycle-oriented multimodality (cycling and fixed-route public transport) could be considered as an efficient tool in developing a sustainable transport system offering adequate transport services to everyone. This study, therefore, explores whether multimodality can support transport equity in a metropolitan urban environment. To this end, a combinatorial approach is adopted; specifically, spatial accessibility as well as horizontal and vertical equity measures related to four scenarios illustrating different transport futures are estimated. These scenarios are the following: (a) existing fixed-route public transport, (b) addition of a new metro line, (c) existing fixed-route public transport and addition of a new metropolitan cycling network, and (d) both a new metro line and a metropolitan cycling network. This method is applied to the Athens Metropolitan Area (AMA) in Greece which comprises a challenging example of a car-oriented metropolis. The main results indicate that bicycle-oriented multimodality influences accessibility positively; however, when it comes to equity (both horizontal and vertical), results require further analysis. Fully multimodal scenarios (Scenario 3) do not lead to better horizontal equity, or they do not support low-income groups; on the contrary, balanced multimodality solutions (Scenario 2) illustrated the most equitable conditions. These findings are indeed surprising, indicating to researchers and practitioners that urban and transport planning should embrace holistic ways to achieve transport equity.

Socioeconomic inequalities associated with Geriatric syndrome in Thailand: The results of Fifth National Health Examination Survey.

Geriatric syndrome (GS) is the prevalence of a group of phenotypes in older people. Functional decline, cognitive impairment, and frailty are common phenotypes that burden individuals, families, and the healthcare system. Policies targeting GS require information on socioeconomic background of older people, which is scarce in Thailand. We investigated socioeconomic inequality associated with GS using the concentration index and further explained the contributions of socioeconomic status and sociodemographic variables to inequality. Nationally representative data of 7,365 individuals aged 60 years and above from the 5th National Health Examination Survey of 2013 were analyzed. The survey used a physical examination, blood test, and questionnaire interviews to elicit personal information, health status, and household assets. The wealth index was used as the main indicator of socioeconomic status, and participants with missing wealth index data were excluded. Three GS phenotypes-frailty, functional impairment (FI) and neurocognitive dysfunction (NCD)-were included. An indirectly standardized concentration index (Cis) and a 95% confidence interval were used to represent the horizontal equity of the three phenotypes. Contributions to the concentration index (CC)-contribution to a more or less equitable GS distribution-were decomposed and shown in terms of percentage and direction. All GS phenotypes were found to be concentrated in the elderly poor (Cis of FI, frailty, and NCD = -0.068, -0.092, and -0.182, respectively). Work status contributes to a more equitable GS distribution in all the phenotypes (%CC in FI, frailty, and NCD = -1.7%, -5.1%, and -2.0%, respectively), whereas types of insurance schemes made bidirectional contributions to the equity of GS. Policies should be adopted to help prevent GS among poor individuals, provide them with an equal opportunity of access to health schemes and ensure opportunities for older Thai individuals to work.

Using an age-grouped Gaussian-based two-step floating catchment area method (AG2SFCA) to measure walking accessibility to urban parks: With an explicit focus on elderly

Rapid population aging has raised the number of elderly residents dramatically, calling out the challenge to provide elders with sufficient and equal urban park spaces in cities with limited land use. Ensuring elders have matched accessibility to urban parks is essential for social sustainability. This study introduces an age-grouped Gaussian-based two-step floating catchment area method (AG2SFCA) to more accurately reflect the urban park accessibility of the elderly and to explore the influence of population aging on residents' accessibility evolution. The applicability and rationality of AG2SFCA are demonstrated through the case study in the Chengdu city center. The results indicate that most elders' urban park accessibility and overall horizontal equity level are overestimated in the previous adjuted 2SFCA approach. There is no unified relationship between residents' accessibility and the population aging condition in their community. However, residents' accessibility is related to the overall aging level of society. Even in the urban core of Chengdu, many elders still have no access to urban parks. The high proximity can help elders maintain their matched accessibility to urban parks despite an aging population. This study enriches the application of 2SFCA-style models and helps provide empirical support to governments, urban planners, and facility operators for targeted decision-making.

Equity in out-of-pocket health expenditure: Evidence from a health insurance program reform in Mexico.

The fragmentation of health systems in low- and middle-income countries (LMICs) deepens health inequities and shifts the economic burden of health care to families via out-of-pocket spending (OOPHE). This problem has been addressed by introducing public health insurance programs for poor people; however, there is a lack of knowledge about how equitable these programs are. We aimed to analyse the long-term effects of the Seguro Popular (SP) voluntary health insurance program, recently phased out and replaced by the Health Institute for Welfare (Instituto de Salud para el Bienestar (INSABI)), on OOPHE equity in the poor Mexican population. We conducted a pooled cross-sectional analysis using eleven waves of the National Household Income and Expenditure Survey (2002-2020). We identified the effect of SP by selecting households without social security (with SP or without health insurance (n = 169 766)) and matched them by propensity score to reduce bias in the decision to enrol in SP. We estimated horizontal and vertical equity metrics and assessed their evolution across subpopulations. The program's entry years (2003-2010) show a positive redistributive effect associated with a focalised stage of the program, while oversaturation could have diluted these effects during 2010-2014, with adverse results in terms of vertical equity and re-ranking among insured families. SP is more horizontally inequitable than for those uninsured. Within SP, the redistributive effect could improve up to 13% if all families with similar expenditures were spending equal OOPHE and horizontal equity was eliminated. Regarding vertical equity, SP outperforms the insured population with middle-range coverage some years after the implementation, but this progress disappears. To achieve universal health coverage, health authorities need to create and execute financial protection mechanisms that effectively address structural inequalities. This involves implementing a more comprehensive risk-pooling mechanism that makes social insurance sustainable in the long-run by increasing the social-economic influx of resources. It is essential to monitor oversaturation and financial sustainability to achieve optimal results. The replacement of the SP with INSABI highlights the complexity of maintaining a social insurance program where the ideology of different governments can influence the program structure, regulation, financing, and even its existence.

Vertical and horizontal equity of wealth taxes: An assessment from a joint income-wealth perspective

Despite an established theoretical literature on (optimal) wealth taxation, the empirical literature is still scarce. Previous studies usually focus on country case studies and a specific type of wealth tax in isolation. This paper analyses from a cross-country perspective the distributional effects of the mix of taxes on wealth, on capital income and on transfers of wealth. Moreover, we use the joint distribution of income and annuitised wealth as our analytical framework. To this end we combine data of the Eurosystem Household Finance and Consumption Survey with the tax-benefit microsimulation model EUROMOD, covering six countries: Belgium, Germany, France, Finland, Italy and Spain. Results indicate that existing wealth taxes do not contribute to vertical and horizontal equity: they are often progressive but do not achieve any significant redistribution due to the low revenues they generate and they imply a much lower burden on those deriving their living standard predominantly from wealth than on those who derive it mainly from income.

Public Mixed Funding for Residential Aged Care Facilities Residents' Needs in the Asia-Pacific Region: A Scoping Review.

Due to population aging and sociodemographic change, there is an increasing reliance on residential aged care facilities in the Asia-Pacific region. Most countries have adopted taxation as the primary means to levy capital for funding universal health services and means-testing of benefits may be further incorporated as a policy balance between horizontal equity and fiscal sustainability. It was hypothesized that residential care needs are evaluated by assessments relating to funding; this scoping review seeks to synthesize how such assessments relate to the care needs of residents. Searches were conducted in concordance with a priori protocol for English-language literature published since 2008 in Embase, CINAHL, PubMed, Scopus, JBI, TROVE, and four peak international organizations for studies and reports that describe the assessment of residents' needs in Asia-Pacific countries that used a mixture of taxation and means-testing to publicly fund residential aged care. One paper and 47 reports were included. Australia, New Zealand, and Singapore utilize a taxation and means-tested user charge approach to fund residential aged care needs. The common care needs assessed include health conditions, daily activities, cognition, psychiatric, and behavioral needs. While essential care needs are publicly funded, other holistic care needs, such as spirituality and autonomy-based needs, still need to be covered for meaningful occupation by the residents.

Indian Tax System: Compliance by Design

&#x0D; Taxes matter. They are required to finance social goods which the markets fail to provide. Since taxes are compulsory payments, it is important to evolve the design and implementation features to ensure effective compliance with the tax to ensure both horizontal and vertical equity. Tax compliance is a multiplicative function of the rate of tax, probability of detection, and penalty rate. The best practice approach to tax policy and reform is to evolve the system with a broad base, and low and less differentiated rates. Such a simple system with reasonable rates minimises the three costs associated with taxes namely, the collection cost to the government, compliance cost to the taxpayer, and distortion cost to the economy. Avoiding multiple objectives makes the tax system simple and broad-based and requires low tax rates to collect a given amount of revenue. A strong technology platform for administering the tax increases the probability of detection and enhances voluntary compliance. The paper discusses the important aspects of tax compliance in terms of design and the importance of technology in the administration of taxes in India.&#x0D;