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

Tinbergen Institute Discussion Paper 2017-031/V

42 Pages Posted: 16 Mar 2017

See all articles by Laura Rossouw

Laura Rossouw

Stellenbosch University - Department of Economics

Teresa Bago d'Uva

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

Eddy van Doorslaer

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Date Written: February 27, 2017

Abstract

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.

Keywords: Self-Assessed Health, Vignettes, Health Measurement, Inequality, South Africa

JEL Classification: D30, D31, I10, I14

Suggested Citation

Rossouw, Laura and Bago d'Uva, Teresa and van Doorslaer, Eddy, Poor Health Reporting? Using Vignettes to Recover the Health Gradient by Wealth (February 27, 2017). Tinbergen Institute Discussion Paper 2017-031/V. Available at SSRN: https://ssrn.com/abstract=2932778 or http://dx.doi.org/10.2139/ssrn.2932778

Laura Rossouw

Stellenbosch University - Department of Economics ( email )

Private Bag X1
Matieland, 7602
South Africa

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

Eddy Van Doorslaer

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Netherlands

Register to save articles to
your library

Register

Paper statistics

Downloads
32
Abstract Views
262
PlumX Metrics