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Education‐related inequity in healthcare with heterogeneous reporting of health

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  • Teresa Bago d'Uva
  • Maarten Lindeboom
  • Owen O'Donnell
  • Eddy van Doorslaer

Abstract

Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in health care utilisation. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of doctor visits in the direction of inequality favouring the better educated. There is a further, and typically larger, shift the same direction when correction is made for the tendency of the better educated to rate their health more negatively.

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Bibliographic Info

Article provided by Royal Statistical Society in its journal Journal of the Royal Statistical Society: Series A (Statistics in Society).

Volume (Year): 174 (2011)
Issue (Month): 3 (07)
Pages: 639-664

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Handle: RePEc:bla:jorssa:v:174:y:2011:i:3:p:639-664

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References

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  1. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
  2. Teresa Bago d'Uva & Andrew M. Jones & Eddy van Doorslaer, 2007. "Measurement of Horizontal Inequity in Health Care Utilisation using European Panel Data," Tinbergen Institute Discussion Papers 07-059/3, Tinbergen Institute.
  3. O'Donnell, Owen & Propper, Carol, 1991. "Equity and the distribution of UK National Health Service resources," Journal of Health Economics, Elsevier, vol. 10(1), pages 1-19, May.
  4. Teresa Bago d’Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O’Donnell & Somnath Chatterji, 2006. "Does reporting heterogeneity bias the measurement of health disparities?," Health, Econometrics and Data Group (HEDG) Working Papers 06/03, HEDG, c/o Department of Economics, University of York.
  5. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income-related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647.
  6. Adriana Lleras-Muney & Frank R. Lichtenberg, 2002. "The Effect of Education on Medical Technology Adoption: Are the More Educated More Likely to Use New Drugs," NBER Working Papers 9185, National Bureau of Economic Research, Inc.
  7. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
  8. Datta Gupta, Nabanita & Kristensen, Nicolai & Pozzoli, Dario, 2010. "External validation of the use of vignettes in cross-country health studies," Economic Modelling, Elsevier, vol. 27(4), pages 854-865, July.
  9. Hans van Kippersluis, & Owen O’Donnell & Eddy van Doorslaer, 2011. "Long-Run Returns to Education: Does Schooling Lead to an Extended Old Age?," Journal of Human Resources, University of Wisconsin Press, vol. 46(4), pages 695-721.
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Cited by:
  1. Ellen van de Poel & Eddy van Doorslaer & Owen O'Donnell, 2011. "Measurement of Inequity in Health Care with Heterogeneous Response of Use to Need," Tinbergen Institute Discussion Papers 11-155/3, Tinbergen Institute.
  2. Layte, Richard & Nolan, Anne, 2013. "Income-Related Inequity in the Use of GP Services: A Comparison of Ireland and Scotland," Papers WP454, Economic and Social Research Institute (ESRI).
  3. A. Geraci & D. Fabbri & C. Monfardini, 2014. "Testing exogeneity of multinomial regressors in count data models: does two stage residual inclusion work?," Working Papers wp921, Dipartimento Scienze Economiche, Universita' di Bologna.
  4. Pfarr, Christian & Schmid, Andreas & Schneider, Udo, 2011. "Reporting Heterogeneity in Self-Assessed Health among Elderly Europeans: The Impact of Mental and Physical Health Status," MPRA Paper 29900, University Library of Munich, Germany.

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