Reporting Heterogeneity in Self-Assessed Health Among Elderly Europeans: The Impact of Mental and Physical Health Status

Abstract

Self-assessed health (SAH) is a frequently used measure of individuals" health status. It is also prone to reporting heterogeneity. To control for reporting heterogeneity valid measures of the objective health status are needed. The topic becomes even more complex for cross-country comparisons, as many key variables tend to vary strongly across countries, influenced by cultural and institutional differences. This study aims at exploring the key drivers for reporting heterogeneity in SAH in an international context. To this end, country specific effects are accounted for and the objective health measure is concretized, separating out effects of mental and physical health conditions. We use panel data from the Survey of Health, Ageing and Retirement in Europe (SHARE) which provides a rich dataset on the elderly European population. To obtain distinct indicators for physical and mental health conditions two indices were constructed. Finally, to identify potential reporting heterogeneity in SAH a generalized ordered probit model is estimated. We find evidence that health behaviour as well as health care utilization, mental and physical health condition as well as country characteristics affect reporting behaviour. We conclude that observed and unobserved heterogeneity play an important role when analysing SAH and have to be taken into account.

Long-term exposure to income inequality: implications for physical functioning at older ages

“…This is particularly important as the majority of the existing literature has focused either on mortality or self-reported health. The latter of which is subject to substantial problems of reporting bias, as we, and others (Barford et al 2010;Jurges 2007;Pfarr et al 2011) have noted.…”

“…Using data from the first wave of SHARE, Jurges (2007) found that, independent of underlying health, there were significant differences between countries in the proportion of people who reported their overall health as 'good'. Similarly, Pfarr et al (2011) showed (also using SHARE data) significant differences in the proportion of people reporting their health as 'poor', independent of their 'true' health status. More importantly for the present study, Pfarr et al (2011) also showed differences between countries in the likelihood that people would report being physically limited by the same specific disease.…”

“…Similarly, Pfarr et al (2011) showed (also using SHARE data) significant differences in the proportion of people reporting their health as 'poor', independent of their 'true' health status. More importantly for the present study, Pfarr et al (2011) also showed differences between countries in the likelihood that people would report being physically limited by the same specific disease. For example, they found that Greek women with a chronic physical condition (osteoporosis) were less likely to report being physically limited than were German women with the same condition.…”

“…Both measures separately capture domains of physical health which are important for older people's capabilities and quality-of-life. These measures are less open to the problem of reporting bias than self-reported limitations (Barford et al 2010;Pfarr et al 2011).…”

Self-rated Health Status of Japanese and Europeans in Later Life: Evidence from JSTAR and SHARE

“…This issue may lead to discrepancies between the SRH and the true health of individuals; some individuals may be more inclined to rate themselves as having better (or worse) health than others even when their true health status is identical. Studies have shown that the threshold health levels may vary by sex (Lindeboom and van Doorslaer, 2004;Kapteyn et al, 2007), age (Groot, 2000;Van Doorslaer and Gerdtham, 2003;Lindeboom and van Doorslaer, 2004;Kapteyn et al, 2007), education (Hernandez-Quevedo et al, 2005;Kapteyn et al, 2007;Pfarr et al, 2011), income (Hernandez-Quevedo et al, 2005 and country of residence (Jürges, 2007;Kapteyn et al, 2007). It has also been argued that the threshold health levels may change over time due to: "changes in social and professional norms, access to health services, and individual behaviour that influence the recognition and classification of symptoms and demand for health care" (Sadana et al, 2000, p. 18).…”