Measurement of Horizontal Inequity in Health Care Utilisation Using European Panel Data

Tinbergen Institute Discussion Paper No. 07-059/3

31 Pages Posted: 4 Aug 2007

See all articles by Teresa Bago d'Uva

Teresa Bago d'Uva

Erasmus University Rotterdam (EUR) - Faculty of Economics; Tinbergen Institute

Andrew M. Jones

University of York - Department of Economics and Related Studies; HEB University of Bergen

Eddy van Doorslaer

Erasmus School of Economics

Date Written: August 2007

Abstract

Measurement of inequity in health care delivery has focused on the extent to which health care utilization is or is not distributed according to need, irrespective of income. Studies using cross-sectional data have proposed various ways of measuring and standardizing for need, but inevitably much of the inter-individual variation in needs remains unobserved in cross-sections. This paper exploits panel data methods to improve the measurement by including the time-invariant part of unobserved heterogeneity into the need-standardization procedure. Using latent class hurdle models for GP and specialist visits estimated on 8 annual waves of the European Community Household Panel we compute indices of horizontal equity that partition total income-related variation in use into a need- and a non-need related part, not only for the observed but also for the unobserved but time-invariant component. We also propose and compare a more conservative index of horizontal inequity to the conventional statistic. We find that many of the cross-country comparative results appear fairly robust to the panel data test, although the panel based methods lead to higher estimates of horizontal inequity for most countries. This confirms that better estimation and control for need often reveals more pro-rich distributions of utilization.

Keywords: inequality, inequity, health care utilisation,; panel data, ECHP

JEL Classification: D30, I10

Suggested Citation

Bago d'Uva, Teresa and Jones, Andrew M. and van Doorslaer, Eddy, Measurement of Horizontal Inequity in Health Care Utilisation Using European Panel Data (August 2007). Available at SSRN: https://ssrn.com/abstract=1004704 or http://dx.doi.org/10.2139/ssrn.1004704

Teresa Bago d'Uva (Contact Author)

Erasmus University Rotterdam (EUR) - Faculty of Economics ( email )

Burgemeester Oudlaan 50
3000 DR Rotterdam, Zuid-Holland 3062PA
Netherlands

Tinbergen Institute ( email )

Burg. Oudlaan 50
Rotterdam, 3062 PA
Netherlands

Andrew M. Jones

University of York - Department of Economics and Related Studies ( email )

Heslington
York, YO1 5DD
United Kingdom
+44-1904-43 3766 (Phone)

HEB University of Bergen ( email )

LOS-senteret
Rosenbergsgt. 39
5015 Bergen
Norway

Eddy Van Doorslaer

Erasmus School of Economics ( email )

Netherlands

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