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Equity in health and health care in a decentralised context: evidence from Canada

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Author Info

  • Dolores Jiménez-Rubio

    (Department of Economics and Related Studies, University of York, York, UK)

  • Peter C. Smith
  • Eddy Van Doorslaer

    (Department of Health Policy and Management, Erasmus University Medical Center and Erasmus School of Economics, Rotterdam, The Netherlands)

Abstract

The impact of administrative decentralisation on equity in health and health care is an important unresolved issue in the health policy debate. Predictions from the limited theoretical literature and the relevant empirical research are both insufficient to draw any firm conclusions. Many countries are nevertheless experimenting with decentralisation policies in the absence of research evidence. This paper presents an exploratory empirical analysis of decentralisation by investigating the spatial dimensions of health-related equity in Canada, a highly decentralised setting. Using data from the 2001 Canadian Community Health Survey, we apply a decomposition method of the Concentration Index to explore whether income-related inequalities in health and inequities in the use of health care are more likely to be due to gaps between rich and poor Canadian provinces rather than to differences between rich and poor individuals within them. The results show that within area variation is the most important source of income-related health inequality, while income-related inequities in health care use are mostly driven by differences between provinces. Copyright © 2007 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1272
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 17 (2008)
Issue (Month): 3 ()
Pages: 377-392

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Handle: RePEc:wly:hlthec:v:17:y:2008:i:3:p:377-392

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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Citations

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Cited by:
  1. Antón, José-Ignacio & Muñoz de Bustillo, Rafael & Fernández-Macías, Enrique & Rivera, Jesús, 2012. "Effects of health care decentralization in Spain from a citizens’ perspective," MPRA Paper 39423, University Library of Munich, Germany.
  2. Jiménez-Rubio, Dolores, 2011. "The impact of fiscal decentralization on infant mortality rates: Evidence from OECD countries," Social Science & Medicine, Elsevier, Elsevier, vol. 73(9), pages 1401-1407.
  3. Fang, Pengqian & Dong, Siping & Xiao, Jingjing & Liu, Chaojie & Feng, Xianwei & Wang, Yiping, 2010. "Regional inequality in health and its determinants: Evidence from China," Health Policy, Elsevier, Elsevier, vol. 94(1), pages 14-25, January.
  4. Jeremiah Hurley & Emmanuel Guindon, 2008. "Private Health Insurance in Canada," Centre for Health Economics and Policy Analysis Working Paper Series, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 2008-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  5. Sara Allin & Jeremiah Hurley, 2008. "Inequity in Publicly Funded Physician Care: What Is The Role Of Private Prescription Drug Insurance?," Centre for Health Economics and Policy Analysis Working Paper Series, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 2008-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  6. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Care Finance and Economics, Springer, Springer, vol. 11(4), pages 287-307, December.
  7. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Care Finance and Economics, Springer, Springer, vol. 10(3), pages 219-237, September.
  8. Hai Zhong, 2010. "The impact of missing data in the estimation of concentration index: a potential source of bias," The European Journal of Health Economics, Springer, Springer, vol. 11(3), pages 255-266, June.

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