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Measurement of Inequity in Health Care with Heterogeneous Response of Use to Need

Author

Listed:
  • Ellen van de Poel

    (Health Policy & Management, Erasmus University Rotterdam)

  • Eddy van Doorslaer

    (Erasmus University Rotterdam)

  • Owen O'Donnell

    (Erasmus University Rotterdam)

Abstract

This discussion paper resulted in an article in the Journal of Health Economics . Volume 31, issue 4, pages 676-689. We propose a method of measuring and decomposing inequity in health care utilisation that allows for heterogeneity in the use-need relationship. This makes explicit inequity that derives from unequal treatment response to variation in need, as well as that due to differential effects of non-need determinants. Under plausible conditions concerning heterogeneity in the use-need relationship and the distribution of need, existing methods that impose homogeneity will underestimate pro-rich inequity. This prediction is confirmed for four low-middle income Asian countries.

Suggested Citation

  • 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.
    • Handle: RePEc:tin:wpaper:20110155
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    1. Capuno, Joseph J., 2007. "Social Health Insurance for the Poor Programs of the Philippines and Vietnam," Philippine Journal of Development PJD 2006 Vol. XXXIII Nos., Philippine Institute for Development Studies.
    2. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    3. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    4. 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.
    5. Hélène Huber, 2008. "Decomposing the causes of inequalities in health care use: a micro-simulations approach," Post-Print hal-02316720, HAL.
    6. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, December.
    7. Oaxaca, Ronald, 1973. "Male-Female Wage Differentials in Urban Labor Markets," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 14(3), pages 693-709, October.
    8. 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, July.
    9. Hélène Huber, 2008. "Decomposing the causes of inequalities in health care use: a micro-simulations approach," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) hal-02316720, HAL.
    10. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    11. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    12. 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.
    13. 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).
    14. 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.
    15. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    16. 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.
    17. Xu, Ke & Ravndal, Frode & Evans, David B. & Carrin, Guy, 2009. "Assessing the reliability of household expenditure data: Results of the World Health Survey," Health Policy, Elsevier, vol. 91(3), pages 297-305, August.
    18. Obermann, Konrad & Jowett, Matthew R. & Alcantara, Maria Ofelia O. & Banzon, Eduardo P. & Bodart, Claude, 2006. "Social health insurance in a developing country: The case of the Philippines," Social Science & Medicine, Elsevier, vol. 62(12), pages 3177-3185, June.
    19. Andrew Jones & Ángel López Nicolás, 2006. "Allowing for heterogeneity in the decomposition of measures of inequality in health," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 4(3), pages 347-365, December.
    20. Andrew Jones, 2004. "Thirteenth European Workshop on Econometrics and Health Economics," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 100-100, January.
    21. Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
    22. Jones, Andrew M. & Rice, Nigel & Robone, Silvana & Dias, Pedro Rosa, 2011. "Inequality and polarisation in health systems' responsiveness: A cross-country analysis," Journal of Health Economics, Elsevier, vol. 30(4), pages 616-625, July.
    23. 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.
    24. 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, September.
    25. Huber, Hélène, 2008. "Decomposing the causes of inequalities in health care use: A micro-simulations approach," Journal of Health Economics, Elsevier, vol. 27(6), pages 1605-1613, December.
    26. 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.
    27. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, vol. 53(9), pages 1149-1162, November.
    28. Matthew Sutton & Peter Lock, 2000. "Regional differences in health care delivery: implications for a national resource allocation formula," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 547-559, September.
    29. Teresa Bago d'Uva & Maarten Lindeboom & Owen O'Donnell & Eddy van Doorslaer, 2011. "Education‐related inequity in healthcare with heterogeneous reporting of health," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 174(3), pages 639-664, July.
    30. 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, October.
    31. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    32. David Neumark, 1988. "Employers' Discriminatory Behavior and the Estimation of Wage Discrimination," Journal of Human Resources, University of Wisconsin Press, vol. 23(3), pages 279-295.
    33. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," The World Bank Economic Review, World Bank, vol. 21(1), pages 93-123.
    34. Hélène Huber, 2008. "Decomposing the causes of inequalities in health care use: A micro-simulations approach," Post-Print halshs-00311162, HAL.
    35. Oaxaca, Ronald L. & Ransom, Michael R., 1994. "On discrimination and the decomposition of wage differentials," Journal of Econometrics, Elsevier, vol. 61(1), pages 5-21, March.
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    Cited by:

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    2. Marta González-Touya & Alexandrina Stoyanova & Rosa M. Urbanos-Garrido, 2021. "COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe?," IJERPH, MDPI, vol. 18(17), pages 1-15, August.
    3. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    4. Knott, R. & Lorgelly, P. & Black, N. & Hollingsworth, B., 2016. "Differential item functioning in the EQ-5D: An exploratory analysis using anchoring vignettes," Health, Econometrics and Data Group (HEDG) Working Papers 16/14, HEDG, c/o Department of Economics, University of York.
    5. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    6. Ricardo Rodrigues & Stefania Ilinca & Andrea E. Schmidt, 2018. "Income‐rich and wealth‐poor? The impact of measures of socio‐economic status in the analysis of the distribution of long‐term care use among older people," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 637-646, March.
    7. Laura Rossouw & Teresa Bago d’Uva & Eddy Doorslaer, 2018. "Poor Health Reporting? Using Anchoring Vignettes to Uncover Health Disparities by Wealth and Race," Demography, Springer;Population Association of America (PAA), vol. 55(5), pages 1935-1956, October.
    8. 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).
    9. Laura Anselmi & Mylène Lagarde & Kara Hanson, 2015. "Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique," Health Economics Review, Springer, vol. 5(1), pages 1-13, December.
    10. Olufunke A. Alaba & Charles Hongoro & Aquina Thulare & Akim Tafadzwa Lukwa, 2021. "Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa," IJERPH, MDPI, vol. 18(13), pages 1-18, July.
    11. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    12. Azharuddin Akhtar & Indrani Roy Chowdhury, 2023. "The socioeconomic inequity in healthcare utilization among individuals with cardiovascular diseases in India," Health Economics, John Wiley & Sons, Ltd., vol. 32(5), pages 1000-1018, May.
    13. Merino Ventosa, María & Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com, 2016. "Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population," Economics & Human Biology, Elsevier, vol. 22(C), pages 216-224.
    14. Zhao, Guangchuan & Cao, Xinbang & Ma, Chao, 2020. "Accounting for horizontal inequity in the delivery of health care: A framework for measurement and decomposition," International Review of Economics & Finance, Elsevier, vol. 66(C), pages 13-24.
    15. Maja Matanic Vautmans & Marijana Oreb & Sasa Drezgic, 2023. "Socioeconomic inequality in the use of long-term care for the elderly in Europe," Public Sector Economics, Institute of Public Finance, vol. 47(2), pages 149-176.
    16. Jihyung Hong & Jaehee Lee, 2019. "Decomposing Income-Related Inequalities in Self-Reported Depression and Self-Rated Health Among Married Immigrants in South Korea," IJERPH, MDPI, vol. 16(10), pages 1-15, May.
    17. Pilar (P.) Garcia-Gomez & Helena M Hernandez-Pizarro & Guillem Lopez-Casasnovas & Joaquim Vidiella-Martin, 2019. "Unravelling Hidden Inequities in a Universal Public Long-Term Care System," Tinbergen Institute Discussion Papers 19-011/V, Tinbergen Institute.
    18. Shmueli, Amir, 2021. "Social solidarity in healthcare: The Israeli case," Social Science & Medicine, Elsevier, vol. 291(C).
    19. Adam Wagstaff & Daniel Cotlear & Patrick Hoang-Vu Eozenou & Leander R. Buisman, 2016. "Measuring progress towards universal health coverage: with an application to 24 developing countries," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 32(1), pages 147-189.
    20. Audrey Dorélien & Hongwei Xu, 2020. "Estimating rural–urban disparities in self-rated health in China: Impact of choice of urban definition," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 43(49), pages 1429-1460.
    21. Stefania Ilinca & Ricardo Rodrigues & Andrea E. Schmidt, 2017. "Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans," IJERPH, MDPI, vol. 14(10), pages 1-15, October.
    22. Raoul Bermejo III & Sonja Firth & Andrew Hodge & Eliana Jimenez-Soto & Willibald Zeck, 2015. "Overcoming Stagnation in the Levels and Distribution of Child Mortality: The Case of the Philippines," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-13, October.

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    More about this item

    Keywords

    health care; equity; decomposition;
    All these keywords.

    JEL classification:

    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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