Sometimes more equal than others: How the choice of welfare indicator can affect the measurement of health inequalities and the incidence of public spending

In recent years, a large body of empirical work has focused on measuring and explaining socioeconomic 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 paper focuses on five key health service outcomes in Mozambique. It uses the concentration index approach to measures both socioeconomic inequality in the utilization of health services and the sensitivity of measured inequality to the choice of welfare indicator. The results illustrate that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on socioeconomic inequalities in service use and on the “perceived” incidence of public spending. The findings point at the need to be cautious in measuring inequality, but also to extend and deepen the analysis of service use.