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Health care deprivation profiles in the measurement of inequality and inequity: an application to GP fundholding in the English NHS

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  • Mauro Laudicella
  • Richard Cookson
  • Andrew Jones
  • Nigel Rice

Abstract

This paper proposes a new approach to the measurement of inequality and inequity in the delivery of health care based on recent contributions to the literature of poverty and deprivation. This approach has some appealing characteristics that enlarge the scope of inequity analysis: 1) the measure of inequity does not rely on socio-economic ranks; 2) inequity can be additively decomposed by population subgroups; 3) the approach provides some indirect control for unobserved need variables; 4) it provides a graphical representation of important aspects of the distribution of inequity; 5) it offers a wide range of indices that are consistent with dominance. The paper provides an empirical illustration investigating the effect of the GP fundholding reform on equity in the most deprived quartile of electoral wards of England in the years 1991 to 1996. Elective hip replacements are used as an indicator of inequity in secondary care. The results show that the most equitable GP practices self-selected into the fundholding scheme in 1991; evidence of an inequity-reducing treatment effect as well as a self-selection effect are found in 1992 and 1993; the self-selection process reduces and no evidence of a treatment effect is present from 1994 to 1996.

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Bibliographic Info

Paper provided by HEDG, c/o Department of Economics, University of York in its series Health, Econometrics and Data Group (HEDG) Working Papers with number 07/28.

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Date of creation: Dec 2007
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Handle: RePEc:yor:hectdg:07/28

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Web page: http://www.york.ac.uk/res/herc/research/hedg/
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Keywords: inequality; inequity; health care; poverty; deprivation; dominance; hip replacements; GP fundholding.;

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  1. Propper, Carol & Croxson, Bronwyn & Shearer, Arran, 2002. "Waiting times for hospital admissions: the impact of GP fundholding," Journal of Health Economics, Elsevier, vol. 21(2), pages 227-252, March.
  2. Andrew M. Jones, 2007. "Panel data methods and applications to health economics," Health, Econometrics and Data Group (HEDG) Working Papers 07/18, HEDG, c/o Department of Economics, University of York.
  3. 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.
  4. Foster, James & Greer, Joel & Thorbecke, Erik, 1984. "A Class of Decomposable Poverty Measures," Econometrica, Econometric Society, vol. 52(3), pages 761-66, May.
  5. Dean Jolliffe & Anastassia Semykina, 2000. "Robust standard errors for the Foster-Greer-Thorbecke class of poverty indices," Stata Technical Bulletin, StataCorp LP, vol. 9(51).
  6. David Madden, 2006. "Body Mass Index and the Measurement of Obesity," Health, Econometrics and Data Group (HEDG) Working Papers 06/11, HEDG, c/o Department of Economics, University of York.
  7. Coral Río & Carlos Gradín & Olga Cantó, 2011. "The measurement of gender wage discrimination: the distributional approach revisited," Journal of Economic Inequality, Springer, vol. 9(1), pages 57-86, March.
  8. 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.
  9. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
  10. Davidson, Russell & Duclos, Jean-Yves, 1998. "Statistical Inference for Stochastic Dominance and for the Measurement of Poverty and Inequality," Cahiers de recherche 9805, Université Laval - Département d'économique.
  11. Dean Jolliffe & Gaurav Datt & Manohar Sharma, 2004. "Robust Poverty and Inequality Measurement in Egypt: Correcting for Spatial-price Variation and Sample Design Effects," Review of Development Economics, Wiley Blackwell, vol. 8(4), pages 557-572, November.
  12. Dusheiko, Mark & Gravelle, Hugh & Jacobs, Rowena & Smith, Peter, 2006. "The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 25(3), pages 449-478, May.
  13. Kakwani, Nanak, 1993. "Statistical Inference in the Measurement of Poverty," The Review of Economics and Statistics, MIT Press, vol. 75(4), pages 632-39, November.
  14. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
  15. Croxson, B. & Propper, C. & Perkins, A., 2001. "Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme," Journal of Public Economics, Elsevier, vol. 79(2), pages 375-398, February.
  16. Jenkins, Stephen P & Lambert, Peter J, 1997. "Three 'I's of Poverty Curves, with an Analysis of UK Poverty Trends," Oxford Economic Papers, Oxford University Press, vol. 49(3), pages 317-27, July.
  17. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862 Elsevier.
  18. 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.
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