IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v108y2014icp10-19.html
   My bibliography  Save this article

From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011

Author

Listed:
  • Siegel, Martin
  • Vogt, Verena
  • Sundmacher, Leonie

Abstract

Individual socio-economic status and the respective socio-economic and political contexts are both important determinants of health. Welfare regimes may be linked with health and health inequalities through two potential pathways: first, they may influence the associations between socio-economic status and health. Second, they may influence the income-related distributions of socio-economic determinants of health within a society. Using the Socio-Economic Panel (SOEP) for the years 1994–2011, we analyze how income-related health inequalities evolved in the context of the transformation from a conservative to a liberal welfare system in Germany. We use the concentration index to measure health inequalities, and the annual concentration indices are decomposed to reveal how the contributions of the explanatory variables age, sex, income, education, and occupation changed over time. The changes in the contributions are further decomposed to distinguish whether changes in health inequalities stem from redistributions of the explanatory variables, from changes in their associations with health, or from changes in their means. Income-related health inequalities to the disadvantage of the economically deprived roughly doubled over time, which can largely be explained by changes in the contributions of individual characteristics representing weaker labor market positions, particularly income and unemployment. The social and labor market reforms coincide with the observed changes in the distributions of these characteristics and, to a lesser extent, with changes of their associations with health.

Suggested Citation

  • Siegel, Martin & Vogt, Verena & Sundmacher, Leonie, 2014. "From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011," Social Science & Medicine, Elsevier, vol. 108(C), pages 10-19.
    • Handle: RePEc:eee:socmed:v:108:y:2014:i:c:p:10-19
    DOI: 10.1016/j.socscimed.2014.02.022
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953614001269
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2014.02.022?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Van Ourti, Tom & van Doorslaer, Eddy & Koolman, Xander, 2009. "The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel," Journal of Health Economics, Elsevier, vol. 28(3), pages 525-539, May.
    2. John Gathergood, 2013. "An Instrumental Variable Approach To Unemployment, Psychological Health And Social Norm Effects," Health Economics, John Wiley & Sons, Ltd., vol. 22(6), pages 643-654, June.
    3. Balia, Silvia & Jones, Andrew M., 2008. "Mortality, lifestyle and socio-economic status," Journal of Health Economics, Elsevier, vol. 27(1), pages 1-26, January.
    4. Lars Kroll & Thomas Lampert, 2011. "Changing health inequalities in Germany from 1994 to 2008 between employed and unemployed adults," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(3), pages 329-339, June.
    5. Jacobi, Lena & Kluve, Jochen, 2006. "Before and After the Hartz Reforms: The Performance of Active Labour Market Policy in Germany," RWI Discussion Papers 41, RWI - Leibniz-Institut für Wirtschaftsforschung.
    6. Chung, Haejoo & Muntaner, Carles, 2007. "Welfare state matters: A typological multilevel analysis of wealthy countries," Health Policy, Elsevier, vol. 80(2), pages 328-339, February.
    7. Navarro, Vicente & Shi, Leiyu, 2001. "The political context of social inequalities and health," Social Science & Medicine, Elsevier, vol. 52(3), pages 481-491, February.
    8. 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.
    9. 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.
    10. Michael Keen, 2002. "The German Tax Reform of 2000," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 9(5), pages 603-621, September.
    11. Rodriguez, E., 2001. "Keeping the unemployed healthy: The effect of means-tested and entitlement benefits in Britain, Germany, and the United States," American Journal of Public Health, American Public Health Association, vol. 91(9), pages 1403-1411.
    12. Gert G. Wagner & Joachim R. Frick & Jürgen Schupp, 2007. "The German Socio-Economic Panel Study (SOEP) – Scope, Evolution and Enhancements," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 127(1), pages 139-169.
    13. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    14. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income‐related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628, July.
    15. 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.
    16. Eikemo, Terje Andreas & Bambra, Clare & Judge, Ken & Ringdal, Kristen, 2008. "Welfare state regimes and differences in self-perceived health in Europe: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 66(11), pages 2281-2295, June.
    17. Coburn, David, 2004. "Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities," Social Science & Medicine, Elsevier, vol. 58(1), pages 41-56, January.
    18. repec:zbw:rwidps:0041 is not listed on IDEAS
    19. repec:dau:papers:123456789/10510 is not listed on IDEAS
    20. Jacobi, Lena & Kluve, Jochen, 2006. "Before and After the Hartz Reforms: The Performance of Active Labour Market Policy in Germany," IZA Discussion Papers 2100, Institute of Labor Economics (IZA).
    21. Nolte, Ellen & McKee, Martin, 2004. "Changing health inequalities in east and west Germany since unification," Social Science & Medicine, Elsevier, vol. 58(1), pages 119-136, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lynn Schelisch & Ricarda Walter, 2021. "Digital Networking in Home-Based Support of Older Adults in Rural Areas: Requirements for Digital Solutions," Sustainability, MDPI, vol. 13(4), pages 1-18, February.
    2. Karmann Alexander & Weinhold Ines & Wende Danny, 2019. "Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany," Review of Economics, De Gruyter, vol. 70(1), pages 69-98, April.
    3. Juan Antonio Córdoba-Doña & Antonio Escolar-Pujolar & Miguel San Sebastián & Per E Gustafsson, 2018. "Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-21, March.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. MAZEIKAITE Gintare & O'DONOGHUE Cathal & SOLOGON Denisa, 2017. "Decomposing health inequality in the EU," LISER Working Paper Series 2017-02, Luxembourg Institute of Socio-Economic Research (LISER).
    2. Nübler, Laura & Busse, Reinhard & Siegel, Martin, 2022. "The role of consumer choice in out-of-pocket spending on health: A mixed-methods approach," EconStor Preprints 260395, ZBW - Leibniz Information Centre for Economics.
    3. David Cantarero & Marta Pascual & Jose Maria Sarabia, 2004. "Can income inequality contribute to understand inequalities in health? An empirical approach based on the European Community Household Panel," ERSA conference papers ersa04p230, European Regional Science Association.
    4. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    5. H. Eme Ichoku & William Fonta & Michael Thiede, 2011. "Socioeconomic gradients in self-rated health: a developing country case study of Enugu State, Nigeria," Economic Change and Restructuring, Springer, vol. 44(3), pages 179-202, August.
    6. Granlund , David & Chuc , NT & Phuc , HD & Lindholm, Lars, 2008. "Inequality in mortality in Vietnam: unravel the causes," Umeå Economic Studies 751, Umeå University, Department of Economics.
    7. Kajal Lahiri & Zulkarnain Pulungan, 2006. "Health Inequality and Its Determinants in New York," Discussion Papers 06-03, University at Albany, SUNY, Department of Economics.
    8. Pedro Rosa Dias, 2009. "Inequality of opportunity in health: evidence from a UK cohort study," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1057-1074, September.
    9. Balia, Silvia & Jones, Andrew M., 2008. "Mortality, lifestyle and socio-economic status," Journal of Health Economics, Elsevier, vol. 27(1), pages 1-26, January.
    10. Lahiri, Kajal & Pulungan, Zulkarnain, 2007. "Income-related health disparity and its determinants in New York state: racial/ethnic and geographical comparisons," MPRA Paper 21694, University Library of Munich, Germany.
    11. Jihyung Hong & Jaehee Lee, 2019. "Decomposing Income-Related Inequalities in Self-Reported Depression and Self-Rated Health Among Married Immigrants in South Korea," IJERPH, MDPI, vol. 16(10), pages 1-15, May.
    12. Pilar García Gómez & Ángel López, 2004. "The evolution of inequity in the access to health care in Spain: 1987-2001," Working Papers, Research Center on Health and Economics 756, Department of Economics and Business, Universitat Pompeu Fabra, revised Oct 2006.
    13. Martin Siegel & Karl Mosler, 2014. "Semiparametric Modeling Of Age‐Specific Variations In Income Related Health Inequalities," Health Economics, John Wiley & Sons, Ltd., vol. 23(7), pages 870-878, July.
    14. Allanson, Paul & Petrie, Dennis, 2013. "Longitudinal methods to investigate the role of health determinants in the dynamics of income-related health inequality," Journal of Health Economics, Elsevier, vol. 32(5), pages 922-937.
    15. Martin Siegel & Andreas Mielck & Werner Maier, 2015. "Individual Income, Area Deprivation, and Health: Do Income‐Related Health Inequalities Vary by Small Area Deprivation?," Health Economics, John Wiley & Sons, Ltd., vol. 24(11), pages 1523-1530, November.
    16. Owen O’Donnell & Eddy van Doorslaer & Adam Wagstaff, 2012. "Decomposition of Inequalities in Health and Health Care," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 17, Edward Elgar Publishing.
    17. Eddy van Doorslaer & Andrew M. Jones, 2004. "Income‐related inequality in health and health care in the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 605-608, July.
    18. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    19. Hai Zhong, 2010. "On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?," International Journal of Health Economics and Management, Springer, vol. 10(4), pages 369-386, December.
    20. Kjell Arne Brekke & Snorre Kverndokk, 2012. "Inadequate Bivariate Measures of Health Inequality: The Impact of Income Distribution," Scandinavian Journal of Economics, Wiley Blackwell, vol. 114(2), pages 323-333, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:108:y:2014:i:c:p:10-19. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.