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Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates

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  • Mohammad Habibullah Pulok

    () (Dalhousie University
    Nova Scotia Health Authority
    University of Technology Sydney (UTS))

  • Kees Gool

    (University of Technology Sydney (UTS))

  • Mohammad Hajizadeh

    (Dalhousie University)

  • Sara Allin

    (The University of Toronto)

  • Jane Hall

    (University of Technology Sydney (UTS))

Abstract

Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and explains inequity which is based on regression analysis, the concentration index, and the decomposition technique. However, this method is not beyond limitations and criticisms, and it has been subject to several methodological challenges in the past decade. This review presents a summary of the recent developments and debates on various methodological issues and their implications on the assessment of HI in healthcare utilisation. We discuss the key disputes centred on measurement scale of healthcare variables as well as the evolution of the decomposition technique. We also highlight the issues about the choice of variables as the indicator of SES in measuring inequity. This follows a discussion on the application of the longitudinal method and use of administrative data to quantify inequity. Future research could exploit the potential for health administrative data linked to social data to generate more comprehensive estimates of inequity across the healthcare continuum. This review would be helpful to guide future applied research to examine inequity in healthcare utilisation.

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  • 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.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:2:d:10.1007_s10198-019-01118-2
    DOI: 10.1007/s10198-019-01118-2
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    as
    1. 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.
    2. Adam Wagstaff, 2011. "The concentration index of a binary outcome revisited," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1155-1160, October.
    3. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    4. Culyer, A. J., 1995. "Need: The idea won't do--But we still need it," Social Science & Medicine, Elsevier, vol. 40(6), pages 727-730, March.
    5. Doorslaer, Eddy van & Wagstaff, Adam & Rutten, Frans (ed.), 1992. "Equity in the Finance and Delivery of Health Care: An International Perspective," OUP Catalogue, Oxford University Press, number 9780192622914.
    6. Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
    7. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    8. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    9. Cookson, R. & Asaria, M. & Ali, S. & Shaw, R. & Doran, T. & Goldblatt, P., 2018. "Health equity monitoring for healthcare quality assurance," Social Science & Medicine, Elsevier, vol. 198(C), pages 148-156.
    10. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    11. Hélène Huber, 2008. "Decomposing the causes of inequalities in health care use: a micro-simulations approach," Post-Print hal-02316720, HAL.
    12. Matthew Sutton, 2002. "Vertical and horizontal aspects of socio‐economic inequity in general practitioner contacts in Scotland," Health Economics, John Wiley & Sons, Ltd., vol. 11(6), pages 537-549, September.
    13. Kim Dalziel & Jinhu Li & Anthony Scott & Philip Clarke, 2018. "Accuracy of patient recall for self‐reported doctor visits: Is shorter recall better?," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1684-1698, November.
    14. 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.
    15. Adam Wagstaff, 2011. "Reply to Guido Erreygers and Tom Van Ourti's comment on ‘The concentration index of a binary outcome revisited’," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1166-1168, October.
    16. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    17. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications, The World Bank, number 6896, November.
    18. Erreygers, Guido & Van Ourti, Tom, 2011. "Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: A recipe for good practice," Journal of Health Economics, Elsevier, vol. 30(4), pages 685-694, July.
    19. 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.
    20. Hélène Huber, 2008. "Decomposing the causes of inequalities in health care use: a micro-simulations approach," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) hal-02316720, HAL.
    21. Adam Wagstaff & Naoko Watanabe, 2003. "What difference does the choice of SES make in health inequality measurement?," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 885-890, October.
    22. Kjellsson, Gustav & Gerdtham, Ulf-G., 2013. "On correcting the concentration index for binary variables," Journal of Health Economics, Elsevier, vol. 32(3), pages 659-670.
    23. 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.
    24. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1989. "Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 89-112, Spring.
    25. Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 803-819, October.
    26. Cookson, Richard & Laudicella, Mauro & Donni, Paolo Li, 2012. "Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008," Social Science & Medicine, Elsevier, vol. 75(8), pages 1514-1522.
    27. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    28. 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.
    29. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
    30. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    31. Allin, S. & Masseria, C. & Mossialos, E., 2009. "Measuring socioeconomic differences in use of health care services by wealth versus by income," American Journal of Public Health, American Public Health Association, vol. 99(10), pages 1849-1855.
    32. Chen, Zhuo & Roy, Kakoli, 2009. "Calculating concentration index with repetitive values of indicators of economic welfare," Journal of Health Economics, Elsevier, vol. 28(1), pages 169-175, January.
    33. 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.
    34. Pulok, Mohammad Habibullah & Sabah, Md Nasim-Us Sabah & Uddin, Jalal & Enemark, Ulrika, 2015. "Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?," MPRA Paper 63496, University Library of Munich, Germany.
    35. Hélène Huber, 2008. "Decomposing the causes of inequalities in health care use: A micro-simulations approach," Post-Print halshs-00311162, HAL.
    36. 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.
    37. Baum, F.E. & Bégin, M. & Houweling, T.A.J. & Taylor, S., 2009. "Changes not for the fainthearted: Reorienting health care systems toward health equity through action on the social determinants of health," American Journal of Public Health, American Public Health Association, vol. 99(11), pages 1967-1974.
    38. Magnus Lindelow, 2006. "Sometimes more equal than others: how health inequalities depend on the choice of welfare indicator," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 263-279, March.
    39. Clarke, Philip & Van Ourti, Tom, 2010. "Calculating the concentration index when income is grouped," Journal of Health Economics, Elsevier, vol. 29(1), pages 151-157, January.
    40. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
    41. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
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    Cited by:

    1. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.

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    More about this item

    Keywords

    Inequity; Healthcare utilisation; Review; Concentration index; Methods;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement

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