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Poor Health Reporting? Using Vignettes to Recover the Health Gradient by Wealth


  • Laura Rossouw

    (Stellenbosch University, South Africa)

  • Teresa Bago d'Uva

    () (Erasmus University Rotterdam, The Netherlands)

  • Eddy van Doorslaer

    () (Erasmus University Rotterdam, The Netherlands, and Stellenbosch University, South Africa)


In spite of the well-known wide disparities in wealth and in objective measures of health like mortality in countries like South Africa, health inequality by wealth in self-reported health measures appears to be nearly non-existent. We test and correct for reporting heterogeneity in sixteen domains of self-assessed health by wealth and race among elderly South Africans using anchoring vignettes. We find that significant reporting differences between high and low wealth groups lead to severe underestimation of the health-wealth gap: poorer individuals rate the same health relatively higher than richer. Using hierarchical ordered probit (HOPIT) modeling, we show that a significant and substantial health disadvantage of the poor emerges after correction. We also address the question whether and how health inequality and reporting heterogeneity are confounded by race. We find that within race groups - especially among Blacks but also among Whites - reporting heterogeneity leads to the underestimation of the health inequalities between richest and poorest. Finally, we show that the apparent Black (vs White) health disadvantage within the top wealth quintile disappears once we correct for reporting tendencies. All in all, our findings suggest that reporting tendencies are an important source of bias in the measurement of health disparities and that anchoring vignettes and HOPIT models can play a role in correcting for these biases.

Suggested Citation

  • Laura Rossouw & Teresa Bago d'Uva & Eddy van Doorslaer, 2017. "Poor Health Reporting? Using Vignettes to Recover the Health Gradient by Wealth," Tinbergen Institute Discussion Papers 17-031/V, Tinbergen Institute.
  • Handle: RePEc:tin:wpaper:20170031

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    References listed on IDEAS

    1. van Doorslaer, Eddy & Gerdtham, Ulf-G., 2003. "Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data," Social Science & Medicine, Elsevier, vol. 57(9), pages 1621-1629, November.
    2. Cécile Charasse-Pouélé & Martin Fournier, 2006. "Health Disparities between racial groups in South Africa - A decomposition Analysis," Post-Print hal-00134778, HAL.
    3. Michael Baker & Mark Stabile & Catherine Deri, 2004. "What Do Self-Reported, Objective, Measures of Health Measure?," Journal of Human Resources, University of Wisconsin Press, vol. 39(4).
    4. Nigel Rice & Silvana Robone & Peter C. Smith, 2012. "Vignettes and health systems responsiveness in cross‐country comparative analyses," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 175(2), pages 337-369, April.
    5. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375.
    6. Cally Ardington & Boingotlo Gasealahwe, 2014. "Mortality in South Africa: Socio-economic profile and association with self-reported health," Development Southern Africa, Taylor & Francis Journals, vol. 31(1), pages 127-145, January.
    7. Fabrice Etilé & Carine Milcent, 2006. "Income-related reporting heterogeneity in self-assessed health: evidence from France," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 965-981.
    8. Martin Fournier & Cécile Charasse-Pouélé, 2006. "Health disparities between racial groups in South Africa: a decomposition analysis," Post-Print halshs-00161711, HAL.
    9. Franco Peracchi & Claudio Rossetti, 2012. "Heterogeneity in health responses and anchoring vignettes," Empirical Economics, Springer, vol. 42(2), pages 513-538, April.
    10. Maarten Lindeboom & Marcel Kerkhofs, 2009. "Health and work of the elderly: subjective health measures, reporting errors and endogeneity in the relationship between health and work," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 24(6), pages 1024-1046.
    11. Charasse-Pouélé, Cécile & Fournier, Martin, 2006. "Health disparities between racial groups in South Africa: A decomposition analysis," Social Science & Medicine, Elsevier, vol. 62(11), pages 2897-2914, June.
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    More about this item


    self-assessed health; vignettes; health measurement; inequality; South Africa;

    JEL classification:

    • D30 - Microeconomics - - Distribution - - - General
    • D31 - Microeconomics - - Distribution - - - Personal Income and Wealth Distribution
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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