Measuring Disparities in Health Care

British Medical Journal, Vol. 333, p. 274, 2006

2 Pages Posted: 5 Oct 2006

See all articles by Jennifer Prah Ruger

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice; University of Pennsylvania - Perelman School of Medicine


Disparities in the quality of health care and in the occurrence of medical errors are hot issues in contemporary medicine and health policy; yet we still have not settled on the right methods for quantifying inequalities. Policy responses will depend on appropriate methods. This article argues that comparing inequalities in health care with respect to a threshold level of health care matters as much if not more than health care disparity gaps between groups. Recent studies using the variation in rates at which those in different demographic subgroups received medical care show that when a technical process quality measure was used, the overall score for quality of care was higher for black and Hispanic people than for white people. This inter-group inequality method masks existing deficits in health care quality. Measuring health care disparities from a shortfall rather than an inter-group perspective selects a threshold or standard below which health performance is judged to be inequitable. An example of a threshold might be achieving 100% immunization coverage for all children. This article argues for using a method of shortfall inequality to measure health care disparities. Comparing groups to one another, without examining the inequities within, fails to fully consider relative deficits in the optimal quality of care and standards of good practice.

Keywords: Health disparity, health policy, inequality

JEL Classification: I00, I18, I10, I11

Suggested Citation

Prah Ruger, Jennifer, Measuring Disparities in Health Care. Available at SSRN:

Jennifer Prah Ruger (Contact Author)

University of Pennsylvania - School of Social Policy & Practice ( email )

3701 Locust Walk
Philadelphia, PA 19104-6214
United States

University of Pennsylvania - Perelman School of Medicine

423 Guardian Drive
Philadelphia, PA 19104
United States

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