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Explaining the Health Equality Paradox of the Welfare State

  • Brekke, Kjell Arne


    (Department of Economics, University of Oslo)

  • Grünfeld, Leo A.


    (Oslo School of Management & MENON Business Economics)

  • Kverndokk, Snorre


    (Ragnar Frisch Centre for Economic Research, UiO)

A growing body of empirical studies have reported that social inequalities in health are as large (or even larger) in the Nordic welfare states than in many less egalitarian societies. This is highly surprising since the welfare state is rooted in income equality, free access to education and health services, and a generous social benefit system. This paper reviews this literature, and provides an explanation of this paradox based on the most common causal mechanism studied, namely the one that goes from income (or another socio economic variable) to health. We start by showing that the concentration index is much more sensitive to health contingent income transfers than income contingent health transfers. Then, we introduce a simple model where health is caused by status (relative income) and show that there actually exists as possibility that stratified societies may have lower health inequality than egalitarian societies, everything else equal, if class is unobservable. Thus, there may be a tradeoff between income and health equality. However, due to the insensitivity of the concentration index of health transfers, this tradeoff may not be shown by such inequality measures. A higher social health inequality as found in empirical studies, may therefore just be a sign of a more equal income distribution.

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Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2011:3.

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Length: 26 pages
Date of creation: 25 Oct 2011
Date of revision:
Handle: RePEc:hhs:oslohe:2011_003
Contact details of provider: Postal: HERO / Institute of Health Management and Health Economics P.O. Box 1089 Blindern, N-0317 Oslo, Norway
Phone: 2307 5309
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  1. Barsky, Robert B, et al, 1997. "Preference Parameters and Behavioral Heterogeneity: An Experimental Approach in the Health and Retirement Study," The Quarterly Journal of Economics, MIT Press, vol. 112(2), pages 537-79, May.
  2. Jennifer M. Mellor & Jeffrey D. Milyo, 2001. "Income inequality and health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 20(1), pages 151-155.
  3. James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
  4. Terkel, Christiansen & Jørgen, Lauridsen & Häkkinen, Unto, 2010. "Determinants of inequalities in health with focus on retired - with particular regard to retired Danes," COHERE Working Paper 2009:4, COHERE - Centre of Health Economics Research, University of Southern Denmark.
  5. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
  6. Sandra E. Black & Paul J. Devereux & Kjell Salvanes, 2005. "From the Cradle to the Labor Market? The Effect of Birth Weight on Adult Outcomes," NBER Working Papers 11796, National Bureau of Economic Research, Inc.
  7. Anne Case & Angela Fertig & Christina Paxson, 2004. "The Lasting Impact of Childhood Health and Circumstance," Working Papers 246, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  8. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
  9. Jere R. Behrman & Mark R. Rosenzweig, 2004. "Returns to Birthweight," The Review of Economics and Statistics, MIT Press, vol. 86(2), pages 586-601, May.
  10. Kjell Arne Brekke & Snorre Kverndokk, 2012. "Inadequate Bivariate Measures of Health Inequality: The Impact of Income Distribution," Scandinavian Journal of Economics, Wiley Blackwell, vol. 114(2), pages 323-333, 06.
  11. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
  12. Jusot, Florence & Kunst, Anton E. & Leinsalu, Mall & Menvielle, Gwenn & Schaap, Maartje M. & Roskam, Albert-Jan R. & Stirbu, Irina & Mackenbach, Johan P., 2008. "Socioeconomic Inequalities in Health in 22 European Countries," Economics Papers from University Paris Dauphine 123456789/10510, Paris Dauphine University.
  13. 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.
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