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Decomposing the causes of inequalities in health care use: A micro-simulations approach

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  • Huber, Hélène

Abstract

We propose an innovative method for the decomposition of factors associated with inequalities in the use of health care. We analyze individual data and make use of micro-simulations to evaluate the effect of heterogeneity of individual behaviors on inequality in access to care. Our study employs methods that, unlike earlier work, permits evaluation of heterogeneity of individual behaviors. We provide an application of this method by decomposing inequality of health care use in France in 1998. We show that half of the inequity in access to care is due to the heterogeneity of behaviors relative to the rank of individuals in the income distribution. This approach reconciles Oaxaca-like decompositions of inequality, focused on outcome gaps, with analyses involving decompositions of inequality by factors, focused on inequity indices.

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  • 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.
    • Handle: RePEc:eee:jhecon:v:27:y:2008:i:6:p:1605-1613
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    1. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    2. 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.
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    5. 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.
    6. Brigitte Dormont & Michel Grignon & Hélène Huber, 2006. "Health expenditure growth: reassessing the threat of ageing," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 947-963, September.
    7. 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.
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    1. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
    2. Lupi-Pegurier, Laurence & Clerc-Urmes, Isabelle & Abu-Zaineh, Mohammad & Paraponaris, Alain & Ventelou, Bruno, 2011. "Density of dental practitioners and access to dental care for the elderly: A multilevel analysis with a view on socio-economic inequality," Health Policy, Elsevier, vol. 103(2), pages 160-167.
    3. Yuejen ZHAO, 2013. "Decomposition of Concentration Index using Generalised Linear Model: Analysis of Socio-Economic Determinants of Health Inequality in the Northern Territory of Australia," Regional and Sectoral Economic Studies, Euro-American Association of Economic Development, vol. 13(1), pages 145-154.
    4. Ziebarth, Nicolas, 2010. "Measurement of health, health inequality, and reporting heterogeneity," Social Science & Medicine, Elsevier, vol. 71(1), pages 116-124, July.
    5. 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.
    6. Philippe Batifoulier & John Latsis & Jacques Merchiers, 2010. "Les priorités de la prise en charge financière des soins. Une approche par la philosophie du besoin," EconomiX Working Papers 2010-2, University of Paris Nanterre, EconomiX.
    7. Abu-Zaineh, Mohammad & Mataria, Awad & Moatti, Jean-Paul & Ventelou, Bruno, 2011. "Measuring and decomposing socioeconomic inequality in healthcare delivery: A microsimulation approach with application to the Palestinian conflict-affected fragile setting," Social Science & Medicine, Elsevier, vol. 72(2), pages 133-141, January.
    8. 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.

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