Unfair Inequalities in Health and Health Care
Posted: 11 Jun 2007
Inequalities in health and health care are caused by different factors. Measuring inequalities of opportunities for health implies that a distinction is introduced between causal variables leading to legitimate (or fair) inequalities on the one hand, and causal variables leading to illegitimate (or unfair) inequalities on the other hand. An example of the former could be life-style choices, an example of the latter is the situation in early childhood or parent's health. We argue that an ethically attractive approach to measuring unfair inequalities (or inequalities in opportunities) should start from a well-specified structural model of health care and health production and we show how to derive measures of unfair inequalities in health and in health care delivery from such a model. Direct unfairness is linked to the variations in medical expenditures and health in the hypothetical distribution in which all legitimate sources of variation are kept constant. The fairness gap is linked to the differences between the actual distribution and the hypothetical distribution in which all illegitimate sources of variation have been removed. These approaches are related to the conditional egalitarian and the egalitarian-equivalent solutions analysed in the theory of fair allocation. In general they lead to different results. We propose to analyse the resulting distributions with the traditional apparatus of Lorenz curves and inequality measures. We compare our proposal to the more traditional approach using concentration curves and analyse the relationship with the methods of direct and indirect standardization. We discuss how inequalities in health care can be integrated in an overall evaluation of social inequality.
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