IDEAS home Printed from https://ideas.repec.org/p/sal/celpdp/0164.html
   My bibliography  Save this paper

Measuring Access and Inequality of Access to Health Care: a Policy-oriented Decomposition

Author

Listed:
  • Abatemarco, Antonio

    (CELPE - CEnter for Labor and Political Economics, University of Salerno, Italy)

  • Aria, Massimo

    (University of Naples "Federico II")

  • Beraldo, Sergio

    (University of Naples "Federico II")

  • Collaro, Michela

    (University of Naples "Federico II")

Abstract

Budget cuts and increasing out-of-pocket expenses have seriously jeopardized access to adequate health care, even where a mandate to provide universal health coverage is well established. In this paper, we propose a non-parametric estimation strategy for the measurement of equality of opportunity in health care within an ex-ante perspective, that is, by focusing on access opportunities of individuals when health needs and utilization decisions have not yet been revealed. In our approach, we account for both (i) the disparity of access among individuals having access and those having not, as well as (ii) the disparity of access conditions across the entire population. The measurement strategy we propose has the great advantage of being factor decomposable in such a way as to allow for the identification of the determinants of observed inequality of access to adequate care. An empirical application to breast cancer in Italy is reported to highlight the informative content of our methodology for policy purposes.

Suggested Citation

  • Abatemarco, Antonio & Aria, Massimo & Beraldo, Sergio & Collaro, Michela, 2023. "Measuring Access and Inequality of Access to Health Care: a Policy-oriented Decomposition," CELPE Discussion Papers 164, CELPE - CEnter for Labor and Political Economics, University of Salerno, Italy.
    • Handle: RePEc:sal:celpdp:0164
    as

    Download full text from publisher

    File URL: https://www.celpe.unisa.it/uploads/rescue/784/1048/164-dp.pdf
    File Function: Full text
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Daniele Fabbri & Silvana Robone, 2010. "The geography of hospital admission in a national health service with patient choice," Health Economics, John Wiley & Sons, Ltd., vol. 19(9), pages 1029-1047, September.
    2. Antonio Abatemarco & Massimo Aria & Sergio Beraldo & Francesca Stroffolini, 2020. "Measuring Disparities in Access to Health Care: A Proposal Based on an Ex-ante Perspective," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(2), pages 549-568, July.
    3. Marc Fleurbaey & Vito Peragine, 2013. "Ex Ante Versus Ex Post Equality of Opportunity," Economica, London School of Economics and Political Science, vol. 80(317), pages 118-130, January.
    4. Foster, James & Greer, Joel & Thorbecke, Erik, 1984. "A Class of Decomposable Poverty Measures," Econometrica, Econometric Society, vol. 52(3), pages 761-766, May.
    5. Blackwood, D. L. & Lynch, R. G., 1994. "The measurement of inequality and poverty: A policy maker's guide to the literature," World Development, Elsevier, vol. 22(4), pages 567-578, April.
    6. Xavier Ramos & Dirk gaer, 2016. "Approaches To Inequality Of Opportunity: Principles, Measures And Evidence," Journal of Economic Surveys, Wiley Blackwell, vol. 30(5), pages 855-883, December.
    7. Chen, Chau-Nan & Tsaur, Tien-Wang & Rhai, Tong-Shieng, 1982. "The Gini Coefficient and Negative Income," Oxford Economic Papers, Oxford University Press, vol. 34(3), pages 473-478, November.
    8. Cowell, Frank A. & Flachaire, Emmanuel, 2007. "Income distribution and inequality measurement: The problem of extreme values," Journal of Econometrics, Elsevier, vol. 141(2), pages 1044-1072, December.
    9. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
    10. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    11. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    12. Giovanni Perucca & Massimiliano Piacenza & Gilberto Turati, 2019. "Spatial inequality in access to healthcare: evidence from an Italian Alpine region," Regional Studies, Taylor & Francis Journals, vol. 53(4), pages 478-489, April.
    13. Kranich, Laurence, 1996. "Equitable Opportunities: An Axiomatic Approach," Journal of Economic Theory, Elsevier, vol. 71(1), pages 131-147, October.
    14. 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.
    15. Shorrocks, A F, 1982. "Inequality Decomposition by Factor Components," Econometrica, Econometric Society, vol. 50(1), pages 193-211, January.
    16. Frank A. Cowell, 2008. "Income Distribution and Inequality," Chapters, in: John B. Davis & Wilfred Dolfsma (ed.), The Elgar Companion to Social Economics, chapter 13, Edward Elgar Publishing.
    17. 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.
    18. Atkinson, Anthony B., 1970. "On the measurement of inequality," Journal of Economic Theory, Elsevier, vol. 2(3), pages 244-263, September.
    19. Lerman, Robert I & Yitzhaki, Shlomo, 1985. "Income Inequality Effects by Income," The Review of Economics and Statistics, MIT Press, vol. 67(1), pages 151-156, February.
    20. Foster, James E. & Shneyerov, Artyom A., 2000. "Path Independent Inequality Measures," Journal of Economic Theory, Elsevier, vol. 91(2), pages 199-222, April.
    21. Paolo Li Donni & Vito Peragine & Giuseppe Pignataro, 2014. "Ex‐Ante And Ex‐Post Measurement Of Equality Of Opportunity In Health: A Normative Decomposition," Health Economics, John Wiley & Sons, Ltd., vol. 23(2), pages 182-198, February.
    22. Antonio Abatemarco & Sergio Beraldo & Francesca Stroffolini, 2020. "Equality of opportunity in health care: access and equal access revisited," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 67(1), pages 13-29, March.
    23. Sergio Beraldo & Michela Collaro & Immacolata Marino, 2020. "Do Harder Local Budget Constraints Affect Patient Mobility?," CSEF Working Papers 580, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    24. Alain Trannoy & Sandy Tubeuf & Florence Jusot & Marion Devaux, 2010. "Inequality of opportunities in health in France: a first pass," Health Economics, John Wiley & Sons, Ltd., vol. 19(8), pages 921-938, August.
    25. Anthony Shorrocks, 2013. "Decomposition procedures for distributional analysis: a unified framework based on the Shapley value," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 11(1), pages 99-126, March.
    26. Berrebi, Z M & Silber, Jacques, 1985. "The Gini Coefficient and Negative Income: A Comment," Oxford Economic Papers, Oxford University Press, vol. 37(3), pages 525-526, September.
    27. Foster, James E & Shorrocks, Anthony F, 1991. "Subgroup Consistent Poverty Indices," Econometrica, Econometric Society, vol. 59(3), pages 687-709, May.
    28. Francesco Andreoli & Mauro Mussini & Vincenzo Prete & Claudio Zoli, 2021. "Urban poverty: Measurement theory and evidence from American cities," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 19(4), pages 599-642, December.
    29. Khan, Abdullah A., 1992. "An integrated approach to measuring potential spatial access to health care services," Socio-Economic Planning Sciences, Elsevier, vol. 26(4), pages 275-287, October.
    30. 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.
    31. repec:dau:papers:123456789/268 is not listed on IDEAS
    32. 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.
    33. 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.
    34. Blakorby, Charles & Donaldson, David, 1980. "Ethical Indices for the Measurement of Poverty," Econometrica, Econometric Society, vol. 48(4), pages 1053-1060, May.
    35. Cylus, Jonathan & Papanicolas, Irene, 2015. "An analysis of perceived access to health care in Europe: How universal is universal coverage?," Health Policy, Elsevier, vol. 119(9), pages 1133-1144.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Antonio Abatemarco & Massimo Aria & Sergio Beraldo & Francesca Stroffolini, 2020. "Measuring Disparities in Access to Health Care: A Proposal Based on an Ex-ante Perspective," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(2), pages 549-568, July.
    2. Davillas, Apostolos & Jones, Andrew M, 2020. "Ex ante inequality of opportunity in health, decomposition and distributional analysis of biomarkers," Journal of Health Economics, Elsevier, vol. 69(C).
    3. Antonio Abatemarco & Sergio Beraldo & Francesca Stroffolini, 2020. "Equality of opportunity in health care: access and equal access revisited," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 67(1), pages 13-29, March.
    4. Peter Lindner, 2015. "Factor decomposition of the wealth distribution in the euro area," Empirica, Springer;Austrian Institute for Economic Research;Austrian Economic Association, vol. 42(2), pages 291-322, May.
    5. Ana Suárez Álvarez & Ana Jesús López Menéndez, 2018. "Assessing Changes Over Time in Inequality of Opportunity: The Case of Spain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 139(3), pages 989-1014, October.
    6. Vincenzo Carrieri & Apostolos Davillas & Andrew M. Jones, 2020. "A latent class approach to inequity in health using biomarker data," Health Economics, John Wiley & Sons, Ltd., vol. 29(7), pages 808-826, July.
    7. John E. Roemer & Alain Trannoy, 2016. "Equality of Opportunity: Theory and Measurement," Journal of Economic Literature, American Economic Association, vol. 54(4), pages 1288-1332, December.
    8. Lanlin Ding & Andrew M. Jones & Peng Nie, 2022. "Ex ante Inequality of Opportunity in Health among the Elderly in China: A Distributional Decomposition Analysis of Biomarkers," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 68(4), pages 922-950, December.
    9. Zhao, Guangchuan & Cao, Xinbang & Ma, Chao, 2020. "Accounting for horizontal inequity in the delivery of health care: A framework for measurement and decomposition," International Review of Economics & Finance, Elsevier, vol. 66(C), pages 13-24.
    10. repec:dau:papers:123456789/13753 is not listed on IDEAS
    11. Pérez-Mesa, David & Marrero, Gustavo A. & Darias-Curvo, Sara, 2021. "Child health inequality in Sub-Saharan Africa," MPRA Paper 108801, University Library of Munich, Germany.
    12. Florence Jusot & Sabine Mage & Marta Menendez, 2014. "Inequality of Opportunity in Health in Indonesia," Working Papers DT/2014/06, DIAL (Développement, Institutions et Mondialisation).
    13. Vincenzo Carrieri & Andrew M. Jones, 2018. "Inequality of opportunity in health: A decomposition‐based approach," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 1981-1995, December.
    14. Kristof Bosmans & Z. Emel Öztürk, 2021. "Measurement of inequality of opportunity: A normative approach," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 19(2), pages 213-237, June.
    15. I. Josa & A. Aguado, 2020. "Measuring Unidimensional Inequality: Practical Framework for the Choice of an Appropriate Measure," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 149(2), pages 541-570, June.
    16. Enza Simeone, 2023. "Inequality in health status during the COVID-19 in the UK: does the impact of the second lockdown policy matter?," Working Papers 661, ECINEQ, Society for the Study of Economic Inequality.
    17. 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.
    18. Paolo Li Donni & Vito Peragine & Giuseppe Pignataro, 2014. "Ex‐Ante And Ex‐Post Measurement Of Equality Of Opportunity In Health: A Normative Decomposition," Health Economics, John Wiley & Sons, Ltd., vol. 23(2), pages 182-198, February.
    19. Davillas, A. & Jones, A.M., 2020. "The COVID-19 pandemic and its impact on inequality of opportunity in psychological distress in the UK," Health, Econometrics and Data Group (HEDG) Working Papers 20/11, HEDG, c/o Department of Economics, University of York.
    20. Barbosa, Estela Capelas & Cookson, Richard, 2019. "Multiple inequity in health care: An example from Brazil," Social Science & Medicine, Elsevier, vol. 228(C), pages 1-8.
    21. Ana Suárez Álvarez & Ana Jesús López Menéndez, 2016. "Inequality of opportunity and income inequality in Spain: An analysis over time," Working Papers 423, ECINEQ, Society for the Study of Economic Inequality.

    More about this item

    Keywords

    health care; equality of opportunity; factor-decomposition; health policy;
    All these keywords.

    JEL classification:

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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sal:celpdp:0164. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Roberto Dell'Anno (email available below). General contact details of provider: https://edirc.repec.org/data/cesalit.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.