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Sometimes more equal than others: how health inequalities depend on the choice of welfare indicator

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  • Magnus Lindelow

    (The World Bank, USA)

Abstract

In recent years, a large body of empirical work has focused on measuring and explaining socio-economic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by per capita consumption or an asset index. Currently, there is only limited information on how the choice of welfare indicators affect the analysis of health inequalities and the incidence of public spending. The purpose of this paper is to illustrate the potential sensitivity of the analysis of health related inequalities to how socioeconomic status is measured. Using data from Mozambique, the paper focuses on five key health service indicators, and tests whether measured inequality (concentration index) in health service utilization differs depending on the choice of welfare indicator. The paper shows that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on measured inequality in utilization of health services. In consequence, we can reach very different conclusions about the 'same' issue depending on how we define socioeconomic status. The paper also provides some tentative conclusions about why and in what contexts health inequalities can be sensitive to the choice of living standards measure. The results call for more clarity and care in the analysis of health related inequalities, and for explicit recognition of the potential sensitivity of findings to the choice of welfare measure. The results also point at the need for more careful research on how different dimensions of SES are related, and on the pathways by which the respective different dimensions impact on health related variables. Copyright © 2005 John Wiley & Sons, Ltd.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:15:y:2006:i:3:p:263-279
    DOI: 10.1002/hec.1058
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    1. Deon Filmer & Kinnon Scott, 2012. "Assessing Asset Indices," Demography, Springer;Population Association of America (PAA), vol. 49(1), pages 359-392, February.
    2. Makate, Marshall & Makate, Clifton, 2016. "The Evolution of Socioeconomic-Related Inequalities in Maternal Healthcare Utilization: Evidence from Zimbabwe, 1994-2011," MPRA Paper 83897, University Library of Munich, Germany, revised 12 Jan 2018.
    3. Mtimet, Nadhem & Baker, Derek & Pica-Ciamarra, Ugo & Jagwe, John, 2013. "Consumer Preferences for Animal Source Foods in Uganda: Quality, Retail Forms and Retail Outlets," International Journal on Food System Dynamics, International Center for Management, Communication, and Research, vol. 4(2).
    4. van Doorslaer, Eddy & O'Donnell, Owen, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008/04, World Institute for Development Economic Research (UNU-WIDER).
    5. repec:ris:badest:0528 is not listed on IDEAS
    6. Mohamad A. Khaled & Paul Makdissi & Rami Tabri & Myra Yazbeck, 2016. "A Framework for Testing the Equality Between the Health Concentration Curve and the 45-Degree Line," Discussion Papers Series 577, School of Economics, University of Queensland, Australia.
    7. Sonne-Schmidt, Christoffer & Tarp, Finn & Østerdal, Lars Peter, 2013. "Ordinal Multidimensional Inequality," WIDER Working Paper Series 097, World Institute for Development Economic Research (UNU-WIDER).
    8. Ziebarth, Nicolas, 2010. "Measurement of health, health inequality, and reporting heterogeneity," Social Science & Medicine, Elsevier, vol. 71(1), pages 116-124, July.
    9. Laura Anselmi & Mylène Lagarde & Kara Hanson, 2015. "Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique," Health Economics Review, Springer, vol. 5(1), pages 1-13, December.
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    11. Amélie Adeline & Eric Delattre, 2017. "Some microeconometric evidence on the relationship between health and income," Health Economics Review, Springer, vol. 7(1), pages 1-18, December.
    12. Ziebarth, Nicolas R. & Frick, Joachim R., 2010. "Revisiting the Income-Health Nexus: The Importance of Choosing the "Right" Indicator," IZA Discussion Papers 4787, Institute for the Study of Labor (IZA).
    13. Baker, Derek & Mtimet, Nadhem & Pica-Ciamarra, Ugo & Nsiima, Longin, 2016. "Consumers’ preferences for animal-source foods and retail outlets: The case of Tanzania," African Journal of Agricultural and Resource Economics, African Association of Agricultural Economists, vol. 11(3), September.
    14. Anselmi, Laura & Lagarde, Mylène & Hanson, Kara, 2015. "Going beyond horizontal equity: An analysis of health expenditure allocation across geographic areas in Mozambique," Social Science & Medicine, Elsevier, vol. 130(C), pages 216-224.
    15. Baris Ucar, 2015. "The Usability of Asset Index as an Indicator of Household Economic Status in Turkey: Comparison with Expenditure and Income Data," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 121(3), pages 745-760, April.
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    17. Frank J. Elgar & Britt McKinnon & Torbjørn Torsheim & Christina Warrer Schnohr & Joanna Mazur & Franco Cavallo & Candace Currie, 2016. "Patterns of Socioeconomic Inequality in Adolescent Health Differ According to the Measure of Socioeconomic Position," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 127(3), pages 1169-1180, July.
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    19. Christoffer Sonne-Schmidt & Finn Tarp & Lars Peter Østerdal, 2008. "Ordinal Comparison of Multidimensional Deprivation: theory and application," Discussion Papers 08-33, University of Copenhagen. Department of Economics.
    20. Costa-Font, Joan & Hernández-Quevedo, Cristina, 2012. "Measuring inequalities in health: What do we know? What do we need to know?," Health Policy, Elsevier, vol. 106(2), pages 195-206.

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