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Education‐related inequity in healthcare with heterogeneous reporting of health

Author

Listed:
  • Teresa Bago d'Uva
  • Maarten Lindeboom
  • Owen O'Donnell
  • Eddy van Doorslaer

Abstract

This discussion paper resulted in a publication in the 'Journal of the Royal Statistical Society' , Series A, 2011, 2011, 174, 639–664. Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in health care utilisation. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of doctor visits in the direction of inequality favouring the better educated. There is a further, and typically larger, shift the same direction when correction is made for the tendency of the better educated to rate their health more negatively.
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Suggested Citation

  • 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.
    • Handle: RePEc:bla:jorssa:v:174:y:2011:i:3:p:639-664
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    Cited by:

    1. 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.
    2. Brilleman, Samuel L. & Gravelle, Hugh & Hollinghurst, Sandra & Purdy, Sarah & Salisbury, Chris & Windmeijer, Frank, 2014. "Keep it simple? Predicting primary health care costs with clinical morbidity measures," Journal of Health Economics, Elsevier, vol. 35(C), pages 109-122.
    3. Richard Layte & Anne Nolan, 2015. "Income-related inequity in the use of GP services by children: a comparison of Ireland and Scotland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 489-506, June.
    4. Caroli, Eve & Weber-Baghdiguian, Lexane, 2016. "Self-reported health and gender: The role of social norms," Social Science & Medicine, Elsevier, vol. 153(C), pages 220-229.
    5. Black, Nicole & Johnston, David W. & Shields, Michael A. & Suziedelyte, Agne, 2017. "Who provides inconsistent reports of their health status? The importance of age, cognitive ability and socioeconomic status," Social Science & Medicine, Elsevier, vol. 191(C), pages 9-18.
    6. Chen, Linkun & Clarke, Philip M. & Petrie, Dennis J. & Staub, Kevin E., 2021. "The effects of self-assessed health: Dealing with and understanding misclassification bias," Journal of Health Economics, Elsevier, vol. 78(C).
    7. Knott, Rachel J. & Lorgelly, Paula K. & Black, Nicole & Hollingsworth, Bruce, 2017. "Differential item functioning in quality of life measurement: An analysis using anchoring vignettes," Social Science & Medicine, Elsevier, vol. 190(C), pages 247-255.
    8. Flavia Cristina Drumond Andrade & Jeenal Deepak Mehta, 2018. "Increasing educational inequalities in self-rated health in Brazil, 1998-2013," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-13, April.
    9. Nicole Black & David W. Johnston & Martin Knapp & Michael A. Shields & Gloria H. Y. Wong, 2025. "Horizontal inequity in the use of mental healthcare in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 34(2), pages 297-315, February.
    10. Pfarr, Christian & Schmid, Andreas & Schneider, Udo, 2011. "Reporting Heterogeneity in Self-Assessed Health among Elderly Europeans: The Impact of Mental and Physical Health Status," MPRA Paper 29900, University Library of Munich, Germany.
    11. 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.
    12. Bonsang, Eric & Caroli, Eve & Garrouste, Clémentine, 2021. "Gender heterogeneity in self-reported hypertension," Economics & Human Biology, Elsevier, vol. 43(C).
    13. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    14. Hanna Grol-Prokopczyk & Emese Verdes-Tennant & Mary McEniry & Márton Ispány, 2015. "Promises and Pitfalls of Anchoring Vignettes in Health Survey Research," Demography, Springer;Population Association of America (PAA), vol. 52(5), pages 1703-1728, October.
    15. 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.
    16. 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).
    17. Geraci Andrea & Fabbri Daniele & Monfardini Chiara, 2018. "Testing Exogeneity of Multinomial Regressors in Count Data Models: Does Two-stage Residual Inclusion Work?," Journal of Econometric Methods, De Gruyter, vol. 7(1), pages 1-19, January.
    18. Thomson, Michael, 2019. "Who had access to doctors before and after new universal capitated subsidies in New Zealand?," Health Policy, Elsevier, vol. 123(8), pages 756-764.
    19. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.
    20. Denzil G. Fiebig & Kees van Gool & Jane Hall & Chunzhou Mu, 2021. "Health care use in response to health shocks: Does socio‐economic status matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3032-3050, December.

    More about this item

    JEL classification:

    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • C42 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Survey Methods
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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