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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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Author Info
Laudicella, M
Cookson, R
Jones, A.M
Rice, N

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Abstract

This paper proposes a new approach to the measurement of inequality and inequity in the delivery of health care based on contributions from the literature on poverty and deprivation. This approach has some appealing characteristics: 1) inequity is additively decomposable by population subgroups; 2) the approach does not rely on socio-economic ranks; 3) it provides a graphical representation of the distribution of inequity; 4) it offers a range of indices consistent with dominance. An empirical application is provided investigating the effect of the GP fundholding reform on equity in English NHS. The results show that the most equitable GP practices self-selected into the scheme in 1991; evidence of an inequity-reducing treatment effect as well as a selfselection effect are found in 1992 and 1993; the self-selection process reduces and no evidence of a treatment effect is present thereafter.

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Publisher 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 08/06.

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Date of creation: Apr 2008
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Handle: RePEc:yor:hectdg:08/06

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Keywords: inequality; inequity; health care; poverty; deprivation; dominance; 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. [Downloadable!] (restricted)
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  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. [Downloadable!]
  3. 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, Blackwell Publishing, vol. 8(4), pages 557-572, November. [Downloadable!] (restricted)
  4. 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. [Downloadable!]
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  5. 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. [Downloadable!] (restricted)
  6. 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. [Downloadable!] (restricted)
  7. Foster, James & Greer, Joel & Thorbecke, Erik, 1984. "A Class of Decomposable Poverty Measures," Econometrica, Econometric Society, vol. 52(3), pages 761-66, May. [Downloadable!] (restricted)
  8. 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. [Downloadable!] (restricted)
  9. 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. [Downloadable!]
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  10. 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. [Downloadable!] (restricted)
  11. Russell Davidson & Jean-Yves Duclos, 2000. "Statistical Inference for Stochastic Dominance and for the Measurement of Poverty and Inequality," Econometrica, Econometric Society, vol. 68(6), pages 1435-1464, November.
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