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Equity in health and health care

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  • FLEURBAEY, Marc

    ()
    (Université Paris-Descartes, France; Université catholique de Louvain, CORE, B-1348 Louvain-la-Neuve, Belgium)

  • SCHOKKAERT, Erik

    ()
    (Department of Economics, K.U.Leuven, Belgium; Université catholique de Louvain, CORE, B-1348 Louvain-la-Neuve, Belgium)

Abstract

We discuss the conceptual foundations of measuring (in)equity in health and health care. After an overview of the recent developments in the measurement of socio-economic inequalities and in racial disparities, we show how these partial approaches can be seen as special cases of the more general social choice approach to fair allocation and equality of opportunity. We suggest that this latter framework offers many new analytical possibilities and is sufficiently rich to accommodate various ethical views. We emphasize that horizontal and vertical equity are intricately linked to each other. We then argue that a focus on overall well-being is necessary to put the partial results on health (care) inequity into a broader perspective and we discuss the pros and cons of various methods to evaluate the joint distribution of health and income: multidimensional inequality indices, dominance approaches, the use of happiness measures and finally the concept of equivalent income. Throughout the chapter the theoretical analysis is complemented with an overview of recent empirical results.

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Paper provided by Université catholique de Louvain, Center for Operations Research and Econometrics (CORE) in its series CORE Discussion Papers with number 2011026.

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Date of creation: 01 Jun 2011
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Handle: RePEc:cor:louvco:2011026

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Keywords: equity; racial disparities; equality of opportunity; equivalent income; dominance;

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  1. Cisse, Boubou & Luchini, Stephane & Moatti, Jean Paul, 2007. "Progressivity and horizontal equity in health care finance and delivery: What about Africa?," Health Policy, Elsevier, vol. 80(1), pages 51-68, January.
  2. Erreygers, Guido & Van Ourti, Tom, 2011. "Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: A recipe for good practice," Journal of Health Economics, Elsevier, vol. 30(4), pages 685-694, July.
  3. Janet Currie, 2009. "Healthy, Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital Development," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 87-122, March.
  4. Shin-Yi Chou & Inas Rashad & Michael Grossman, 2005. "Fast-Food Restaurant Advertising on Television and Its Influence on Childhood Obesity," NBER Working Papers 11879, National Bureau of Economic Research, Inc.
  5. Erik Schokkaert & Carine Van De Voorde, 2007. "Direct versus indirect standaardization in risk adjustment," Center for Economic Studies - Discussion papers ces0733, Katholieke Universiteit Leuven, Centrum voor Economische Studiën.
  6. Fleurbaey,Marc & Maniquet,François, 2011. "A Theory of Fairness and Social Welfare," Cambridge Books, Cambridge University Press, number 9780521715348, April.
  7. ERREYGERS, Guido, 2006. "Correcting the Concentration Index," Working Papers 2006027, University of Antwerp, Faculty of Applied Economics.
  8. Bruno S. Frey & Alois Stutzer, 2002. "What Can Economists Learn from Happiness Research?," Journal of Economic Literature, American Economic Association, vol. 40(2), pages 402-435, June.
  9. Thibault Gajdos & John A. Weymark, 2003. "Multidimensional Generalized Gini Indices," Vanderbilt University Department of Economics Working Papers 0311, Vanderbilt University Department of Economics, revised Jul 2003.
  10. Ada Ferrer-i-Carbonell & Bernard M.S. van Praag, 2002. "The subjective costs of health losses due to chronic diseases. An alternative model for monetary appraisal," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 709-722.
  11. Milanovic, Branko, 1997. "A simple way to calculate the Gini coefficient, and some implications," Economics Letters, Elsevier, vol. 56(1), pages 45-49, September.
  12. Le Grand, Julian, 1987. "Inequalities in health : Some international comparisons," European Economic Review, Elsevier, vol. 31(1-2), pages 182-191.
  13. M. Fleurbaey., 2012. "Beyond GDP: The Quest for a Measure of Social Welfare," VOPROSY ECONOMIKI, N.P. Redaktsiya zhurnala "Voprosy Economiki", vol. 3.
  14. Anne Case & Angela Fertig & Christina Paxson, 2004. "The Lasting Impact of Childhood Health and Circumstance," Working Papers 246, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  15. Schokkaert, Erik & Van de Voorde, Carine, 2004. "Risk selection and the specification of the conventional risk adjustment formula," Journal of Health Economics, Elsevier, vol. 23(6), pages 1237-1259, November.
  16. Anne Case & Darren Lubotsky & Christina Paxson, 2002. "Economic Status and Health in Childhood: The Origins of the Gradient," American Economic Review, American Economic Association, vol. 92(5), pages 1308-1334, December.
  17. Blackorby, Charles & Donaldson, David, 1988. "Money metric utility: A harmless normalization?," Journal of Economic Theory, Elsevier, vol. 46(1), pages 120-129, October.
  18. Bleichrodt, Han & van Doorslaer, Eddy, 2006. "A welfare economics foundation for health inequality measurement," Journal of Health Economics, Elsevier, vol. 25(5), pages 945-957, September.
  19. Balia S & Jones A.M, 2009. "Catching the habit: a study of inequality of opportunity in smoking-related mortality," Health, Econometrics and Data Group (HEDG) Working Papers 09/08, HEDG, c/o Department of Economics, University of York.
  20. Indranil Dutta & Prasanta K. Pattanaik & Yongsheng Xu, 2003. "On Measuring Deprivation and the Standard of Living in a Multidimensional Framework on the Basis of Aggregate Data," Economica, London School of Economics and Political Science, vol. 70(278), pages 197-221, 05.
  21. Arnaud LEFRANC, Nicolas PISTOLESI, Alain TRANNOY, 2009. "Equality of opportunity and luck: De nitions and testable conditions, with an application to income in France," THEMA Working Papers 2009-01, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
  22. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
  23. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities, and health achievement," Policy Research Working Paper Series 2765, The World Bank.
  24. Carol Graham & Lucas Higuera & Eduardo Lora, 2011. "Which health conditions cause the most unhappiness?," Health Economics, John Wiley & Sons, Ltd., vol. 20(12), pages 1431-1447, December.
  25. Shorrocks, A F, 1982. "Inequality Decomposition by Factor Components," Econometrica, Econometric Society, vol. 50(1), pages 193-211, January.
  26. Robert Sandy & Gilbert Liu & John Ottensmann & Rusty Tchernis & Jeff Wilson & O. T. Ford, 2011. "Studying the Child Obesity Epidemic with Natural Experiments," NBER Chapters, in: Economic Aspects of Obesity, pages 181-221 National Bureau of Economic Research, Inc.
  27. Marc Fleurbaey & Alain Trannoy, 2003. "The impossibility of a Paretian egalitarian," Social Choice and Welfare, Springer, vol. 21(2), pages 243-263, October.
  28. Ramses H. Abul Naga & Pierre-Yves Geoffard, 2005. "Decomposition of bivariate inequality indices by attributes," PSE Working Papers halshs-00590715, HAL.
  29. Tsui Kai-Yuen, 1995. "Multidimensional Generalizations of the Relative and Absolute Inequality Indices: The Atkinson-Kolm-Sen Approach," Journal of Economic Theory, Elsevier, vol. 67(1), pages 251-265, October.
  30. Andrew M. Jones & Ángel López, 2003. "Measurement and explanation of socioeconomic inequality in health with longitudinal data," Economics Working Papers 711, Department of Economics and Business, Universitat Pompeu Fabra.
  31. Adam Wagstaff & Eddy van Doorslaer, 2004. "Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 297-301.
  32. N. GRAVEL & Patrick MOYES (GREThA UMR CNRS 5113), 2008. "Bidimensional Inequalities with an Ordinal Variable," Cahiers du GREThA 2008-14, Groupe de Recherche en Economie Théorique et Appliquée.
  33. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income-related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628.
  34. Teresa Bago d’Uva & Andrew M. Jones & Eddy van Doorslaer, 2007. "Measurement of horizontal inequity in health care utilisation using European Panel data," Health, Econometrics and Data Group (HEDG) Working Papers 07/17, HEDG, c/o Department of Economics, University of York.
  35. Gaertner,Wulf & Schokkaert,Erik, 2011. "Empirical Social Choice," Cambridge Books, Cambridge University Press, number 9781107013940, April.
  36. FLEURBAYE, Marc & LUCHINI, Stéphane & MULLER, Christophe & SCHOKKAERT, Eric, 2010. "Equivalent income and the economic evaluation of health care," CORE Discussion Papers 2010006, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
  37. Van de Poel, Ellen & O'Donnell, Owen & Van Doorslaer, Eddy, 2007. "Are urban children really healthier? Evidence from 47 developing countries," Social Science & Medicine, Elsevier, vol. 65(10), pages 1986-2003, November.
  38. Matthew Sutton, 2002. "Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland," Health Economics, John Wiley & Sons, Ltd., vol. 11(6), pages 537-549.
  39. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933.
  40. Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
  41. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
  42. Kolm, Serge-Christophe, 1977. "Multidimensional Egalitarianisms," The Quarterly Journal of Economics, MIT Press, vol. 91(1), pages 1-13, February.
  43. Lu, Jui-fen R. & Leung, Gabriel M. & Kwon, Soonman & Tin, Keith Y.K. & Van Doorslaer, Eddy & O'Donnell, Owen, 2007. "Horizontal equity in health care utilization evidence from three high-income Asian economies," Social Science & Medicine, Elsevier, vol. 64(1), pages 199-212, January.
  44. Bryan Bollinger & Phillip Leslie & Alan Sorensen, 2011. "Calorie Posting in Chain Restaurants," American Economic Journal: Economic Policy, American Economic Association, vol. 3(1), pages 91-128, February.
  45. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432.
  46. Alan S. Blinder, 1973. "Wage Discrimination: Reduced Form and Structural Estimates," Journal of Human Resources, University of Wisconsin Press, vol. 8(4), pages 436-455.
  47. Florence Jusot & Sandy Tubeuf & Alain Trannoy, 2010. "Effort or Circumstances: Does the Correlation Matter for Inequality of Opportunity in Health?," Working Papers DT33, IRDES institut for research and information in health economics, revised Jul 2010.
  48. Jean-Yves Duclos & Damien Echevin, 2008. "Health and income: A robust comparison of Canada and the US," Cahiers de recherche 08-08, Departement d'Economique de la Faculte d'administration à l'Universite de Sherbrooke.
  49. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding differences in health behaviors by education," Journal of Health Economics, Elsevier, vol. 29(1), pages 1-28, January.
  50. John Cawley & Christopher Ruhm, 2011. "The Economics of Risky Health Behaviors," NBER Working Papers 17081, National Bureau of Economic Research, Inc.
  51. Wim Groot & Henri�tte Maassen van den Brink, 2006. "The compensating income variation of cardiovascular disease," Health Economics, John Wiley & Sons, Ltd., vol. 15(10), pages 1143-1148.
  52. Marc Fleurbaey & Guillaume Gaulier, 2009. "International Comparisons of Living Standards by Equivalent Incomes," Scandinavian Journal of Economics, Wiley Blackwell, vol. 111(3), pages 597-624, 09.
  53. Clarke, Philip M. & Gerdtham, Ulf-G. & Johannesson, Magnus & Bingefors, Kerstin & Smith, Len, 2002. "On the measurement of relative and absolute income-related health inequality," Social Science & Medicine, Elsevier, vol. 55(11), pages 1923-1928, December.
  54. Allanson, Paul, 2010. "Longitudinal analysis of income-related health inequality: welfare foundations and alternative measures," SIRE Discussion Papers 2010-71, Scottish Institute for Research in Economics (SIRE).
  55. Wim Groot & Henri�tte Maassen van den Brink & Erik Plug, 2004. "Money for health: the equivalent variation of cardiovascular diseases," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 859-872.
  56. Diana De Graeve & Tom Van Ourti, 2003. "The Distributional Impact of Health Financing in Europe: A Review," The World Economy, Wiley Blackwell, vol. 26(10), pages 1459-1479, November.
  57. Wagstaff, Adam & Van Doorslaer, Eddy & Watanabe, Naoko, 2001. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Policy Research Working Paper Series 2714, The World Bank.
  58. Bourguignon, Francois, 1989. "Family size and social utility : Income distribution dominance criteria," Journal of Econometrics, Elsevier, vol. 42(1), pages 67-80, September.
  59. Duranton, Gilles & Martin, Philippe & Mayer, Thierry & Mayneris, Florian, 2010. "The Economics of Clusters: Lessons from the French Experience," OUP Catalogue, Oxford University Press, number 9780199592203, September.
  60. Janet Currie & Mark Stabile, 2003. "Socioeconomic Status and Child Health: Why Is the Relationship Stronger for Older Children?," American Economic Review, American Economic Association, vol. 93(5), pages 1813-1823, December.
  61. Xander Koolman & Eddy van Doorslaer, 2004. "On the interpretation of a concentration index of inequality," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 649-656.
  62. Elisha A. Pazner & David Schmeidler, 1975. "Egalitarian Equivalent Allocations: A New Concept of Economic Equity," Discussion Papers 174, Northwestern University, Center for Mathematical Studies in Economics and Management Science.
  63. Belleflamme,Paul & Peitz,Martin, 2010. "Industrial Organization," Cambridge Books, Cambridge University Press, number 9780521681599, April.
  64. John E. Roemer, 2002. "Equality of opportunity: A progress report," Social Choice and Welfare, Springer, vol. 19(2), pages 455-471, April.
  65. Scott F. Richard, 1975. "Multivariate Risk Aversion, Utility Independence and Separable Utility Functions," Management Science, INFORMS, vol. 22(1), pages 12-21, September.
  66. Gerard J. van den Berg & Maarten Lindeboom & France Portrait, 2006. "Economic Conditions Early in Life and Individual Mortality," American Economic Review, American Economic Association, vol. 96(1), pages 290-302, March.
  67. Tobin, James, 1970. "On Limiting the Domain of Inequality," Journal of Law and Economics, University of Chicago Press, vol. 13(2), pages 263-77, October.
  68. Atkinson, Anthony B & Bourguignon, Francois, 1982. "The Comparison of Multi-Dimensioned Distributions of Economic Status," Review of Economic Studies, Wiley Blackwell, vol. 49(2), pages 183-201, April.
  69. Pedro Rosa Dias, 2009. "Inequality of opportunity in health: evidence from a UK cohort study," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1057-1074.
  70. Anand, Paul & Dolan, Paul, 2005. "Equity, capabilities and health," Social Science & Medicine, Elsevier, vol. 60(2), pages 219-222, January.
  71. Allanson, Paul & Petrie, Dennis & Gerdtham, Ulf-G, 2008. "Longitudinal analysis of income-related health inequality," SIRE Discussion Papers 2008-38, Scottish Institute for Research in Economics (SIRE).
  72. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
  73. Trannoy, A & Tubeuf, S & Jusot, F & Devaux, M, 2008. "Inequality in Opportunities in Health in France: A first pass," Health, Econometrics and Data Group (HEDG) Working Papers 08/24, HEDG, c/o Department of Economics, University of York.
  74. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412.
  75. Samuelson, Paul A, 1974. "Complementarity-An Essay on the 40th Anniversary of the Hicks-Allen Revolution in Demand Theory," Journal of Economic Literature, American Economic Association, vol. 12(4), pages 1255-89, December.
  76. Doorslaer, Eddy van & Jones, Andrew M., 2003. "Inequalities in self-reported health: validation of a new approach to measurement," Journal of Health Economics, Elsevier, vol. 22(1), pages 61-87, January.
  77. Pedro Rosa Dias & Andrew M. Jones, 2007. "Giving equality of opportunity a fair innings," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 109-112.
  78. Gary S. Becker & Tomas J. Philipson & Rodrigo R. Soares, 2005. "The Quantity and Quality of Life and the Evolution of World Inequality," American Economic Review, American Economic Association, vol. 95(1), pages 277-291, March.
  79. Roemer, John E., 1985. "Equality of Talent," Economics and Philosophy, Cambridge University Press, vol. 1(02), pages 151-188, October.
  80. King, Mervyn A., 1983. "Welfare analysis of tax reforms using household data," Journal of Public Economics, Elsevier, vol. 21(2), pages 183-214, July.
  81. 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.
  82. Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 803-819.
  83. Samuelson, Paul A & Swamy, S, 1974. "Invariant Economic Index Numbers and Canonical Duality: Survey and Synthesis," American Economic Review, American Economic Association, vol. 64(4), pages 566-93, September.
  84. Bommier, Antoine & Stecklov, Guy, 2002. "Defining health inequality: why Rawls succeeds where social welfare theory fails," Journal of Health Economics, Elsevier, vol. 21(3), pages 497-513, May.
  85. 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.
  86. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
  87. Muller, Christophe & Trannoy, Alain, 2012. "Multidimensional inequality comparisons: A compensation perspective," Journal of Economic Theory, Elsevier, vol. 147(4), pages 1427-1449.
  88. Marc Fleurbaey, 2005. "Health, Wealth, and Fairness," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 7(2), pages 253-284, 05.
  89. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
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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. 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.
  3. Jusot, Florence & Bricard, Damien, 2012. "Intergenerational transmission of health care habits in France," Economics Papers from University Paris Dauphine 123456789/10720, Paris Dauphine University.

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