Equity in the Finance and Delivery of Health Care: Some Tentative Cross-Country Comparisons

Abstract

1 We arc grateful to Frans Ruttcn for support throughout the research leading up to this paper, to the Centro Europa Riccrche (CER) in Rome-and in particular to Stefania Gabriel-for providing data from the CER Health Care Consumption Survey, to Ugo Ercolani and George France for help in obtaining data on Italian health care expenditure; and to Jaap van den Berg of the Dutch Central Bureau of Statistics (CBS) for providing pre-rclcasc versions of recently published tables from the CBS Health Interview Survey. 2 Lc Grand finds that 'the top socioeconomic group (professionals, employers and managers) receives 40 per cent more NHS expenditure per person reporting illness than the bottom one (semi-skilled and unskilled manual workers)' (Le Grand, 1982, p. 46).

Sometimes more equal than others: how health inequalities depend on the choice of welfare indicator

“…6 Many of these measures have been developed to summarize grouped data on health outcomes and service utilization, and do not meet what may be considered basic criteria for inequality measures . However, the concentration index, which is directly related to the concentration curve, has been proposed as a superior measure, with the ability to capture the experiences of whole population, and to reflect changes in the distribution as they occur across the population (Wagstaff, van Doorslaer, and Paci 1989). The concentration index is based on the techniques and indices of progressivity and distributive effect developed in the public finance literature (e.g., Kakwani 1977), and has been applied in relation to both health and health care (e.g., Propper and Upward 1992;Schalick and others 2000;van Doorslaer, Wagstaff, and Bleichrod 1997).…”

“…1 Some research has also focused on socioeconomic inequalities in the distribution of health services or public spending on health care. In OECD countries, this work has been concerned with horizontal equity in the delivery of health care (LeGrand 1978;Propper and Upward 1992;Rosenzweig and Schultz 1991;van Doorslaer and others 2000;van Doorslaer and Wagstaff 1992;Wagstaff, van Doorslaer, and Paci 1989). In contrast, most work on the distribution of health services in developing countries has focused on the narrower issue of equality.…”

Progressivity, horizontal equity and reranking in health care finance: a decomposition analysis for the Netherlands

“…The first of these issues has received a good deal of attention recently in the literature on health care financing (cf. Hurst, 1985;Gottschalk et al, 1989;Wagstaff et al, 1989;Wagstaff and van Doorslaer, 1992;van Doorslaer et al, 1993b). The second and third issues, by contrast, have received virtually no attention in this literature.…”

Allowing for heterogeneity in the decomposition of measures of inequality in health*

“…The health Gini was proposed by LeGrand (1989) and discussed by Wagstaff et al (1991) who also advocated the use of concentration indices for income-related health inequality (Wagstaff et al, 1989). Many health economists have concentrated their attention on socioeconomic inequalities in health, in particular, income-related inequalities (see e.g., Wagstaff et al, 1989;van Doorslaer and Koolman, 2004).…”

“…Silber, 1988, Wagstaff et al, 1989, 1991, 1994, and van Doorslaer et al 1997. Like the Gini coefficient of income inequality, the Gini and concentration indices for health have the attraction that they can be decomposed by factors (see e.g., Rao, 1969, Kakwani, 1980.…”