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Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model

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  • Tom Van Ourti

Abstract

We estimate the determinants of utilisation of physician and hospital services in Belgium using a one‐ and two‐part panel count data model, and a one‐ and two‐part pooled count data model. We conclude that the two‐part panel count data model is most appropriate as it controls for unobserved heterogeneity and allows for a two‐part decision‐making process. The estimates of the determinants of utilisation of health care are then used to calculate indices of horizontal inequity. We find that inequity for general practitioner and hospital services is stable across time and in favour of low‐income individuals, in the sense that, overall, they consume more than one would expect on the basis of their need, albeit the indices for hospital care are not significant. Horizontal equity applies to specialist care in all years, but from 1999 onwards, some evidence (although not statistically significant) of pro‐rich inequity is found. Copyright © 2004 John Wiley & Sons, Ltd.

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  • Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    • Handle: RePEc:wly:hlthec:v:13:y:2004:i:7:p:705-724
    DOI: 10.1002/hec.920
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    3. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    4. Clarke, Philip & Van Ourti, Tom, 2010. "Calculating the concentration index when income is grouped," Journal of Health Economics, Elsevier, vol. 29(1), pages 151-157, January.
    5. Teresa Bago d'Uva, 2006. "Latent class models for utilisation of health care," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 329-343, April.
    6. Erik Schokkaert & Tom Van Ourti & Diana De Graeve & Ann Lecluyse & Carine Van de Voorde, 2010. "Supplemental health insurance and equality of access in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 377-395, April.
    7. Jonas Fooken & Varinder Jeet, 2022. "Using Australian panel data to account for unobserved factors in measuring inequities for different channels of healthcare utilization," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 717-728, June.
    8. Joan Gil & Paolo Li Donni & Eugenio Zucchelli, 2019. "Uncontrolled diabetes and health care utilisation: A bivariate latent Markov model approach," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1262-1276, November.
    9. Ignacio Abásolo & Jaime Pinilla & Miguel Negrín, 2008. "Equity in the utilization of public health care services by regions in Spain: a multinivel analysis," Hacienda Pública Española / Review of Public Economics, IEF, vol. 187(4), pages 87-106, December.
    10. Francesco Renna & Vasilios D. Kosteas & Kuchibhotla Dinkar, 2021. "Inequality in health insurance coverage before and after the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 30(2), pages 384-402, February.
    11. Ignacio Abásolo & Miguel Negrín & Jaime Pinilla, 2014. "Utilización y tiempos de espera: dos vertientes inseparables del análisis de la equidad en el acceso al sistema sanitario público," Hacienda Pública Española / Review of Public Economics, IEF, vol. 208(1), pages 11-38, March.
    12. José Murteira & Óscar Lourenço, 2011. "Health care utilization and self-assessed health: specification of bivariate models using copulas," Empirical Economics, Springer, vol. 41(2), pages 447-472, October.
    13. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    14. Chen, Zhuo & Roy, Kakoli, 2009. "Calculating concentration index with repetitive values of indicators of economic welfare," Journal of Health Economics, Elsevier, vol. 28(1), pages 169-175, January.
    15. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    16. Grasdal, Astrid & Monstad, Karin, 2009. "Inequity in the use of physician services in Norway. Changing patterns over time," Working Papers in Economics 05/09, University of Bergen, Department of Economics.
    17. Yonghua Li & Qinchuan Ran & Song Yao & Likun Ding, 2023. "Evaluation and Optimization of the Layout of Community Public Service Facilities for the Elderly: A Case Study of Hangzhou," Land, MDPI, vol. 12(3), pages 1-29, March.
    18. Pulok, Mohammad Habibullah & Hajizadeh, Mohammad, 2022. "Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults," Social Science & Medicine, Elsevier, vol. 307(C).
    19. Eddy van Doorslaer & Andrew M. Jones, 2004. "Income‐related inequality in health and health care in the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 605-608, July.
    20. Cavagnero, Eleonora & Bilger, Marcel, 2010. "Equity during an economic crisis: Financing of the Argentine health system," Journal of Health Economics, Elsevier, vol. 29(4), pages 479-488, July.
    21. Philip Clarke & Tom Van Ourti, 2009. "Correcting the Bias in the Concentration Index when Income is Grouped," CEPR Discussion Papers 599, Centre for Economic Policy Research, Research School of Economics, Australian National University.
    22. Wouterse, Bram & Huisman, Martijn & Meijboom, Bert R. & Deeg, Dorly J.H. & Polder, Johan J., 2013. "Modeling the relationship between health and health care expenditures using a latent Markov model," Journal of Health Economics, Elsevier, vol. 32(2), pages 423-439.
    23. McLeod, Logan, 2011. "A nonparametric vs. latent class model of general practitioner utilization: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 30(6), pages 1261-1279.
    24. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.

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