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Measuring equity in access to health care

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  • Waters, Hugh R.

Abstract

This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to health care -- a concentration coefficient derived from the Gini coefficient, and the Atkinson distributional measure -- and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article defines access as the use of health care by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose affiliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic health care demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted per-capita household expenditure. The study also predicts health care use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to health care, but has a negative impact on equity in the distribution of health services. The benefits of the program, calculated as its marginal impact on the probability of using of health care, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the benefit more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar effects, although less important in magnitude.

Suggested Citation

  • Waters, Hugh R., 2000. "Measuring equity in access to health care," Social Science & Medicine, Elsevier, vol. 51(4), pages 599-612, August.
  • Handle: RePEc:eee:socmed:v:51:y:2000:i:4:p:599-612
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    References listed on IDEAS

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    1. Newbold, K. Bruce & Eyles, John & Birch, Stephen, 1995. "Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada," Social Science & Medicine, Elsevier, vol. 40(9), pages 1181-1192, May.
    2. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    3. 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.
    4. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    5. Gerdtham, U. -G. & Johannesson, M. & Lundberg, L. & Isacson, D., 1999. "A note on validating Wagstaff and van Doorslaer's health measure in the analysis of inequalities in health," Journal of Health Economics, Elsevier, vol. 18(1), pages 117-124, January.
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    Cited by:

    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. Boris Kralj, 2001. "Physician Distribution and Physician Shortage Intensity in Ontario," Canadian Public Policy, University of Toronto Press, vol. 27(2), pages 167-178, June.
    3. Núñez Ares, José & de Vries, Harwin & Huisman, Dennis, 2016. "A column generation approach for locating roadside clinics in Africa based on effectiveness and equity," European Journal of Operational Research, Elsevier, vol. 254(3), pages 1002-1016.
    4. Trani, Jean-Francois & Bakhshi, Parul & Noor, Ayan A. & Lopez, Dominique & Mashkoor, Ashraf, 2010. "Poverty, vulnerability, and provision of healthcare in Afghanistan," Social Science & Medicine, Elsevier, vol. 70(11), pages 1745-1755, June.
    5. Alessio Petrelli & Roberta Picariello & Giuseppe Costa, 2010. "Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services," International Journal of Health Economics and Management, Springer, vol. 10(1), pages 29-42, March.
    6. Waters, Hugh R. & Bós, Antonio M., 2008. "The financial protection impact of the public health system and private insurance in Brazil," Revista CEPAL, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), August.
    7. repec:gam:jsusta:v:10:y:2018:i:2:p:333-:d:129090 is not listed on IDEAS
    8. Pia Schneider & Kara Hanson, 2006. "Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 19-31.
    9. Núñez Ares, J. & de Vries, H. & Huisman, D., 2015. "A Column Generation Approach for Locating Roadside Clinics in Africa based upon Effectiveness and Equity," Econometric Institute Research Papers EI2015-19, Erasmus University Rotterdam, Erasmus School of Economics (ESE), Econometric Institute.
    10. Shengelia, Bakhuti & Tandon, Ajay & Adams, Orvill B. & Murray, Christopher J.L., 2005. "Access, utilization, quality, and effective coverage: An integrated conceptual framework and measurement strategy," Social Science & Medicine, Elsevier, vol. 61(1), pages 97-109, July.
    11. Steven Prus, 2007. "Age, SES, and Health: A Population Level Analysis of Health Inequalities over the Life Course," Social and Economic Dimensions of an Aging Population Research Papers 181, McMaster University.
    12. Kim, Tae Jun & Vonneilich, Nico & Lüdecke, Daniel & von dem Knesebeck, Olaf, 2017. "Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries," Social Science & Medicine, Elsevier, vol. 176(C), pages 158-165.

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