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The evolution of income-related health inequalities in Switzerland over time

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  • Robert E. Leu
  • Martin Schellhorn

Abstract

This paper presents new evidence on income-related health inequality and its development over time in Switzerland. We employ the methods lined out in van Doorslaer and Jones (2003) and van Doorslaer and Koolman (2004) measuring health using an interval regression approach to compute concentration indices and decomposing inequality into its determining factors. Nationally representative survey data for 1982, 1992, 1997 and 2002 are used to carry out the analysis. Looking at each of the four years separately the results indicates the usual positive relationship between income and health, but the distribution is among the least unequal in Europe. No clear trend emerges in the evolution of the inequality indices over the two decades. Inequality is somewhat lower in 1982 and 1992 as compared to 1997 and 2002 but the differences are not significant. The most important contributors to health inequality are income, education and activity status, in particular retirement. Regional differences including the widely varying health care supply, by contrast, do not exert any systematic influence

Suggested Citation

  • Robert E. Leu & Martin Schellhorn, 2004. "The evolution of income-related health inequalities in Switzerland over time," Diskussionsschriften dp0414, Universitaet Bern, Departement Volkswirtschaft.
    • Handle: RePEc:ube:dpvwib:dp0414
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    References listed on IDEAS

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    1. Martin Schellhorn, 2001. "The effect of variable health insurance deductibles on the demand for physician visits," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 441-456, July.
    2. van Doorslaer, Eddy & Gerdtham, Ulf-G., 2003. "Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data," Social Science & Medicine, Elsevier, vol. 57(9), pages 1621-1629, November.
    3. 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.
    4. Leu, Robert E. & Schellhorn, Martin, 2004. "The Evolution of Income-Related Inequalities in Health Care Utilization in Switzerland over Time," IZA Discussion Papers 1316, Institute of Labor Economics (IZA).
    5. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics,, Palgrave Macmillan.
    6. 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.
    7. Robert E. Leu & Martin Schellhorn, 2004. "The evolution of income-related inequalities in health care utilization in Switzerland over time," Diskussionsschriften dp0413, Universitaet Bern, Departement Volkswirtschaft.
    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. Leu, Robert E. & Schellhorn, Martin, 2004. "The Evolution of Income-Related Health Inequalities in Switzerland over Time," IZA Discussion Papers 1346, Institute of Labor Economics (IZA).
    10. 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.
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    Cited by:

    1. Leu, Robert E. & Schellhorn, Martin, 2004. "The Evolution of Income-Related Health Inequalities in Switzerland over Time," IZA Discussion Papers 1346, Institute of Labor Economics (IZA).
    2. Heckley, Gawain A. & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2014. "A New Approach to Decomposition of a Bivariate Rank Dependent Index Using Recentered Influence Function Regression," Working Papers 2014:36, Lund University, Department of Economics, revised 01 Apr 2015.
    3. Ana I. Balsa & Máximo Rossi & Patricia Triunfo, 2011. "Horizontal Inequity in Access to Health Care in Four South American Cities," Revista de Economía del Rosario, Universidad del Rosario, June.
    4. Mosca, Ilaria, 2006. "Is decentralisation the real solution?: A three country study," Health Policy, Elsevier, vol. 77(1), pages 113-120, June.
    5. Bilger, Marcel, 2008. "Progressivity, horizontal inequality and reranking caused by health system financing: A decomposition analysis for Switzerland," Journal of Health Economics, Elsevier, vol. 27(6), pages 1582-1593, December.
    6. Gaillard, Gabrielle, 2007. "Equity and Health," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 8(4), pages 67-80.
    7. Michael Gerfin & Martin Schellhorn, 2006. "Nonparametric bounds on the effect of deductibles in health care insurance on doctor visits – Swiss evidence," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 1011-1020, September.
    8. Gerdtham, Ulf-G & Lundborg, Petter & Lyttkens, Carl Hampus & Nystedt, Paul, 2012. "Do Socioeconomic Factors Really Explain Income-Related Inequalities in Health? Applying a Twin Design to Standard Decomposition Analysis," Working Papers 2012:21, Lund University, Department of Economics.
    9. Paul, Pavitra & Valtonen, Hannu, 2015. "Health inequality in the Russian Federation: An examination of the changes in concentration and achievement indices from 1994 to 2013," MPRA Paper 70150, University Library of Munich, Germany, revised 05 Feb 2016.
    10. 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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    More about this item

    Keywords

    Inequalities in health; concentration index; decomposition analysis;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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