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Estimating and explaining differences in income related inequality in health across general practices

  • Mark Dusheiko
  • Hugh Gravelle
  • Stephen Campbell

We use data on individual patients in general practices to examine whether income related inequality in self reported health differs across general practices and whether such differences are explained by characteristics of the practices. We allow for the simultaneous determination of health and income by instrumenting income. We also allow for item non response for the income question by a two stage selection model. We find that item non response has little effect on the estimated relationship between income and health but that allowing for simultaneity doubles the estimated effect of income on health. We show that there are significant differences in the effect of income on health across practices and that these differences are related to the number of patients per GP, a measure of practice prescribing quality, and the provision of out of hours services.

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Paper provided by Department of Economics, University of York in its series Discussion Papers with number 02/07.

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Handle: RePEc:yor:yorken:02/07
Contact details of provider: Postal: Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
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  1. Smith, Richard J & Blundell, Richard W, 1986. "An Exogeneity Test for a Simultaneous Equation Tobit Model with an Application to Labor Supply," Econometrica, Econometric Society, vol. 54(3), pages 679-85, May.
  2. 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.
  3. Joshua D. Angrist & Alan B. Krueger, 2001. "Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments," Journal of Economic Perspectives, American Economic Association, vol. 15(4), pages 69-85, Fall.
  4. Angrist, J.D., 1996. "Conditional Independance in Sample Selection Models," Working papers 96-27, Massachusetts Institute of Technology (MIT), Department of Economics.
  5. Brazier, John & Roberts, Jennifer & Deverill, Mark, 2002. "The estimation of a preference-based measure of health from the SF-36," Journal of Health Economics, Elsevier, vol. 21(2), pages 271-292, March.
  6. 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.
  7. 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.
  8. Joshua D. Angrist, 1995. "Conditioning on the Probability of Selection to Control Selection Bias," NBER Technical Working Papers 0181, National Bureau of Economic Research, Inc.
  9. Ettner, Susan L., 1996. "New evidence on the relationship between income and health," Journal of Health Economics, Elsevier, vol. 15(1), pages 67-85, February.
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