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Unfair inequalities in health and health care

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  • FLEURBAEY, Marc
  • SCHOKKAERT, Erik

Abstract

Inequalities in health and health care are caused by different factors. Measuring "unfair"inequalities implies that a distinction is introduced between causal variables leading toethically legitimate inequalities and causal variables leading to ethically illegitimateinequalities. An example of the former could be life-style choices, an example of the latter issocial background. We show how to derive measures of unfair inequalities in health and in health care delivery from a structural model of health care and health production: “direct unfairness”, linked to the variations in medical expenditures and health in the hypothetical distribution in which all legitimate sources of variation are kept constant; “fairness gap”, linked to the differences between the actual distribution and the hypothetical distribution in which all illegitimate sources of variation have been removed. These two approaches are related to the theory of fair allocation. In general they lead to different results. We propose to analyse the resulting distributions with the traditional apparatus of Lorenz curves and inequality measures. We compare our proposal to the more common approach using concentration curves and analyse the relationship with the methods of direct and indirect standardization. We discuss how inequalities in health care can be integrated in an overall evaluation of social inequality.

Suggested Citation

  • FLEURBAEY, Marc & SCHOKKAERT, Erik, 2007. "Unfair inequalities in health and health care," LIDAM Discussion Papers CORE 2007090, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
  • Handle: RePEc:cor:louvco:2007090
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    References listed on IDEAS

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    1. Marc Fleurbaey, 2006. "Health, equity and social welfare," Annals of Economics and Statistics, GENES, issue 83-84, pages 21-59.
    2. Abul Naga, Ramses H. & Geoffard, Pierre-Yves, 2006. "Decomposition of bivariate inequality indices by attributes," Economics Letters, Elsevier, vol. 90(3), pages 362-367, March.
    3. Gary S. Becker & Tomas J. Philipson & Rodrigo R. Soares, 2005. "The Quantity and Quality of Life and the Evolution of World Inequality," American Economic Review, American Economic Association, vol. 95(1), pages 277-291, March.
    4. Bommier, Antoine & Stecklov, Guy, 2002. "Defining health inequality: why Rawls succeeds where social welfare theory fails," Journal of Health Economics, Elsevier, vol. 21(3), pages 497-513, May.
    5. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
    6. Schokkaert, Erik & Van de Voorde, Carine, 2004. "Risk selection and the specification of the conventional risk adjustment formula," Journal of Health Economics, Elsevier, vol. 23(6), pages 1237-1259, November.
    7. Roland Luttens & Dirk gaer, 2007. "Lorenz Dominance and Non-welfaristic Redistribution," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 28(2), pages 281-302, February.
    8. 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.
    9. 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.
    10. 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.
    11. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    12. repec:adr:anecst:y:2006:i:83-84:p:10 is not listed on IDEAS
    13. Pedro Rosa Dias & Andrew M. Jones, 2007. "Giving equality of opportunity a fair innings," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 109-112, February.
    14. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, vol. 53(9), pages 1149-1162, November.
    15. Marc Fleurbaey, 2003. "Social Welfare, Priority to the Worst-Off And the Dimensions of Individual Well-Being," IDEP Working Papers 0312, Institut d'economie publique (IDEP), Marseille, France.
    16. ERREYGERS, Guido, 2006. "Beyond the Health Concentration Index: An Atkinson alternative for the measurement of the socioeconomic inequality of health," Working Papers 2006029, University of Antwerp, Faculty of Business and Economics.
    17. Fleurbaey, Marc, 2012. "Fairness, Responsibility, and Welfare," OUP Catalogue, Oxford University Press, number 9780199653591.
    18. 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.
    19. Mackenbach, Johan P. & Kunst, Anton E., 1997. "Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe," Social Science & Medicine, Elsevier, vol. 44(6), pages 757-771, March.
    20. 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.
    21. 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.
    22. 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.
    23. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
    24. Marc Fleurbaey, 2005. "Health, Wealth, and Fairness," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 7(2), pages 253-284, May.
    25. Adam Wagstaff & Eddy van Doorslaer, 2004. "Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 297-301, March.
    26. 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.
    27. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, vol. 18(3), pages 263-290, June.
    28. 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.
    29. 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.
    30. Erik Schokkaert & Carine Van De Voorde, 2006. "Incentives for risk selection and omitted variables in the risk adjustment formula," Annals of Economics and Statistics, GENES, issue 83-84, pages 327-351.
    31. John E. Roemer, 2002. "Equality of opportunity: A progress report," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 19(2), pages 455-471.
    32. repec:adr:anecst:y:2006:i:83-84:p:02 is not listed on IDEAS
    33. Mooney, Gavin & Hall, Jane & Donaldson, Cam & Gerard, Karen, 1991. "Utilisation as a measure of equity: weighing heat?," Journal of Health Economics, Elsevier, vol. 10(4), pages 475-480.
    34. Tsuchiya, Aki & Williams, Alan, 2005. "A "fair innings" between the sexes: are men being treated inequitably?," Social Science & Medicine, Elsevier, vol. 60(2), pages 277-286, January.
    35. Williams, Alan & Cookson, Richard, 2000. "Equity in health," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 35, pages 1863-1910, Elsevier.
    36. 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.
    37. Erik Schokkaert & Geert Dhaene & Carine Van De Voorde, 1998. "Risk adjustment and the trade‐off between efficiency and risk selection: an application of the theory of fair compensation," Health Economics, John Wiley & Sons, Ltd., vol. 7(5), pages 465-480, August.
    38. 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.
    39. Xander Koolman & Eddy van Doorslaer, 2004. "On the interpretation of a concentration index of inequality," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 649-656, July.
    40. repec:adr:anecst:y:2006:i:83-84:p:13 is not listed on IDEAS
    41. Hurley, Jeremiah, 2000. "An overview of the normative economics of the health sector," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 2, pages 55-118, Elsevier.
    42. Bleichrodt, Han & van Doorslaer, Eddy, 2006. "A welfare economics foundation for health inequality measurement," Journal of Health Economics, Elsevier, vol. 25(5), pages 945-957, September.
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    More about this item

    Keywords

    equity in health care delivery; health inequality; social welfare;
    All these keywords.

    JEL classification:

    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I10 - Health, Education, and Welfare - - Health - - - General

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