Horizontal Inequity in Access to Healthcare Services and Educational Level in Spain
AbstractThe aim of this study is to measure horizontal equity in the use of healthcare services in Spain, proposing two methodological innovations. First by defending it as equality of access for equal need, irrespective of educational level, unlike the prevailing methodological approach to horizontal equity which relates it to income. Second, by estimating it by means of the slope index of the inequality of characteristics, analagous to the inequity index proposed by Kakwani, Wagstaff and van Doorslaer (1997; HIWV) but presenting some methodological advantages, the greater robustness of the data available on educational level than of those on income, and the possibility of isolating the net effect of the educational level on the use of healthcare by controlling for other variables. The methodology is designed in three parts: (1) estimation of the relationship between the educational level and the use of healthcare services by means of a model of the likelihood of demand for healthcare services, commonly used in the literature; (2) estimation of the relationship between educational level and health by approximating a production function of individuals' health according to their personal characteristics and other factors conditioning health; and (3) estimation of the slope index of inequality as a measure of horizontal inequity, using educational level instead of income as the criterion for ranking individuals. The data base used was a sample of 55,598 observations from the Survey of disabilities, handicaps and state of health of 1999, carried out in Spain. No significant statistical association was found between educational level and use of healthcare services. On the other hand, the relationship between educational level and health, with the three proxy variables used (perception of health, days of limitation and number of chronic illnesses) shows a positive correlation, i.e. an increase in educational level is associated with a greater probability of enjoying better health. Horizontal inequity, measured by the proposed slope index of inequality, gives a range of statistically significant values between 13.91% and 9.40%, depending on cases, i.e. the significant inverse relationship between state of health and educational level is not reflected proportionally in healthcare use, implying that, with greater need, the access of individuals with a lower educational level to public healthcare services is the same as for the rest. These results suggest that the educational level may be a variable to consider when characterizing the healthcare needs of a population in a defined geographical area, at least from the normative characterization of horizontal equity proposed
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Bibliographic InfoPaper provided by Faculty of Economics and Business (University of Granada) in its series FEG Working Paper Series with number 08/03.
Length: 22 pages
Date of creation: 16 Nov 2008
Date of revision:
Education and health; Healthcare needs; Horizontal Inequity; Logistic regression ; Ordinal regression; Regional funding;
Find related papers by JEL classification:
- C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
- H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
- H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
- I12 - Health, Education, and Welfare - - Health - - - Health Production
- I20 - Health, Education, and Welfare - - Education - - - General
This paper has been announced in the following NEP Reports:
- NEP-ALL-2009-03-22 (All new papers)
- NEP-EDU-2009-03-22 (Education)
- NEP-HEA-2009-03-22 (Health Economics)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Victor R. Fuchs, 1982.
"Time Preference and Health: An Exploratory Study,"
NBER Working Papers
0539, National Bureau of Economic Research, Inc.
- Sickles, Robin C & Taubman, Paul, 1986.
"An Analysis of the Health and Retirement Status of the Elderly,"
Econometric Society, vol. 54(6), pages 1339-56, November.
- Robin C. Sickles & Paul J. Taubman, 1984. "An Analysis of the Health and Retirement Status of the Elderly," NBER Working Papers 1459, National Bureau of Economic Research, Inc.
- Haveman, Robert & Wolfe, Barbara & Kreider, Brent & Stone, Mark, 1994.
"Market work, wages, and men's health,"
Journal of Health Economics,
Elsevier, vol. 13(2), pages 163-182, July.
- Haveman, Robert & Wolfe, Barbara & Kreider, Brent & Stone, Mark, 1994. "Market Work, Wages, and Men's Health," Staff General Research Papers 10233, Iowa State University, Department of Economics.
- Robert Haveman & Mark Stone & Barbara Wolfe, 1989. "Market Work, Wages, and Men's Health," NBER Working Papers 3020, National Bureau of Economic Research, Inc.
- Mark C. Berger & J. Paul Leigh, 1989. "Schooling, Self-Selection, and Health," Journal of Human Resources, University of Wisconsin Press, vol. 24(3), pages 433-455.
- Wagstaff, Adam, 1986. "The demand for health : Some new empirical evidence," Journal of Health Economics, Elsevier, vol. 5(3), pages 195-233, September.
- van Doorslaer, Eddy & Wagstaff, Adam & Bleichrodt, Han & Calonge, Samuel & Gerdtham, Ulf-G. & Gerfin, Michael & Geurts, Jose & Gross, Lorna & Hakkinen, Unto & Leu, Robert E., 1997. "Income-related inequalities in health: some international comparisons," Journal of Health Economics, Elsevier, vol. 16(1), pages 93-112, February.
- Sergi Jiménez-Martín & José Labeaga & Maite Martínez-Granado, 2004.
"An empirical analysis of the demand for physician services across the European Union,"
The European Journal of Health Economics,
Springer, vol. 5(2), pages 150-165, May.
- Sergi Jiménez-Martín & José M. Labeaga & Maite Martínez-Granado, 2003. "An Empirical Analysis of the Demand for Physician Services Across the European Union," Economic Working Papers at Centro de Estudios Andaluces E2003/45, Centro de Estudios Andaluces.
- Wagstaff, Adam, 2002.
"Inequality aversion, health inequalities, and health achievement,"
Policy Research Working Paper Series
2765, The World Bank.
- Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
- Anderson, Kathryn H. & Burkhauser, Richard V., 1984. "The importance of the measure of health in empirical estimates of the labor supply of older men," Economics Letters, Elsevier, vol. 16(3-4), pages 375-380.
- Sergi Jiménez-Mart�n & José M. Labeaga & Maite Mart�nez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321.
- Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
- 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.
- Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
- 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.
- John Bound, 1991. "Self-Reported Versus Objective Measures of Health in Retirement Models," Journal of Human Resources, University of Wisconsin Press, vol. 26(1), pages 106-138.
- Kemna, Harrie J. M. I., 1987. "Working conditions and the relationship between schooling and health," Journal of Health Economics, Elsevier, vol. 6(3), pages 189-210, September.
- repec:pri:cheawb:255 is not listed on IDEAS
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