Determinants of relative and absolute concentration indices: evidence from 26 European countries

International Journal for Equity in Health

Dagný Ósk Ragnarsdóttir¹  Tinna Laufey Ásgeirsdóttir¹ 

[1] Department of Economics, University of Iceland, Oddi v/Sturlugotu 101, Reykjavik, Iceland

关键词: Europe;    Gross income;    Net income;    Income;    Health;    Health-income inequalities;    Decomposition;    Concentration index;   

Others  :  811760
DOI  :  10.1186/1475-9276-12-53

 received in 2013-05-28, accepted in 2013-07-15,  发布年份 2013

【 摘 要 】

Introduction

The aim of publicly-provided health care is generally not only to produce health, but also to decrease variation in health by socio-economic status. The aim of this study is to measure to what extent this goal has been obtained in various European countries and evaluate the determinants of inequalities within countries, as well as cross-country patterns with regard to different cultural, institutional and social settings.

Methods

The data utilized in this study provides information on 440,000 individuals in 26 European countries and stem from The European Union Statistics on Income and Living Conditions (EU-SILC) collected in 2007. As measures of income-related inequality in health both the relative concentration indices and the absolute concentration indices are calculated. Further, health inequality in each country is decomposed into individual-level determinants and cross-country comparisons are made to shed light on social and institutional determinants.

Results

Income-related health inequality favoring the better-off is observed for all the 26 European countries. In terms of within-country determinants inequality is mainly explained by income, age, education, and activity status. However, the degree of inequality and contribution of each determinant to inequality varies considerably between countries. Aggregate bivariate linear regressions show that there is a positive association between health-income inequality in Europe and public expenditure on education. Furthermore, a negative relationship between health-income inequality and income inequality was found when individual employee cash income was used in the health-concentration measurement. Using that same income measure, health-income inequality was found to be higher in the Nordic countries than in other areas, but this result is sensitive to the income measure chosen.

Conclusions

The findings indicate that institutional determinants partly explain income-related health inequalities across countries. The results are in accordance with previously published theories hypothesizing social mobility as the explanation for differences in health-income inequalities between countries and higher health-income inequality could be a result of lower income inequality.

【 授权许可】

   
2013 Ásgeirsdóttir and Ragnarsdóttir; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]OECD: Health expenditure and financing. Paris: OECD Publishing; 2009. [Health at a glance: OECD indicators]
• [2]Illsey R, Le Grand J: The measurement of inequality in health. In Health and economics. Edited by Williams A. London: Macmillan; 1987.
• [3]Le Grand J: Inequalities in health - some international comparisons. Eur Econ Rev 1987, 31:182-191.
• [4]Le Grand J: An international comparison of distributions of ages-at-death. In Health Inequality in European Countries. Edited by Fox J. Aldershot: Gower; 1989.
• [5]Wagstaff A, van Doorslaer E: Income inequality and health: what does the literature tell us? Annu Rev Publ Health 2000, 21:543-567.
• [6]Mackenbach JP, Kunst AE, Cavelaars AEJM, Groenhof F, Geurts JJM, Andersen O, Bonte JTP, Borgan JK, Crialesi R, Desplanques G, Filakti H, Harding S, Grotvedt L, Helmert U, Junker C, Lahelma E, Lundberg O, Martikainen P, Matheson J, Mielck A, Minder CE, Mizrahi A, Mizrahi A, Pagnanelli F, Rasmussen N, Regidor E, Spuhler T, Valkonen T: Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet 1997, 349:1655-1659.
• [7]Cavelaars AEJM, Kunst AE, Geurts JJM, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Mizrahi A, Mizrahi A, Rasmussen NK, Regidor E, Spuhler T, Mackenbach JP: Differences in self reported morbidity by educational level: a comparison of 11 Western European countries. J Epidemiol Commun H 1998, 52:219-227.
• [8]Propper C, Upward R: Need, equity and the NHS: the distribution of health care expenditure 1974–87. Fisc Stud 1992, 13:1-21.
• [9]Van Doorslaer E, Wagstaff A, Bleichrodt H, Calonge S, Gerdtham UG, Gerfin M, Geurts J, Gross L, Hakkinen U, Leu RE, ODonnell O, Propper C, Puffer F, Rodriguez M, Sundberg G, Winkelhake O: Income-related inequalities in health: Some international comparisons. J Health Econ 1997, 16:93-112.
• [10]Humphries KH, van Doorslaer E: Income-related health inequality in Canada. Soc Sci Med 2000, 50:663-671.
• [11]Clarke P, Smith L: More or less equal? comparing Australian income-related inequality in self-reported health with other industrialised countries. Aust Nz J Publ Heal 2000, 24:370-373.
• [12]Ásgeirsdóttir TL: Lifestyle Economics: A Health and Labor-market Analysis of Iceland. Saarbrücken: VDM Verlag; 2008.
• [13]Van Doorslaer E, Koolman X: Explaining the differences in income-related health inequalities across European countries. Health Econ 2004, 13:609-628.
• [14]Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. New Engl J Med 2008, 358:2468-2481.
• [15]Eikemo TA, Bambra C, Joyce K, Dahl E: Welfare state regimes and income-related health inequalities: a comparison of 23 European countries. Eur J Public Health 2008, 18:593-599.
• [16]Bambra C, Eikemo TA: Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. J Epidemiol Community Health 2009, 63:92-98.
• [17]Eikemo TA, Huisman M, Bambra C, Kunst AE: Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Ill 2008, 30:565-582.
• [18]Miething A, Lundberg O, Geyer S: Income and health in different welfare contexts: a comparison of Sweden, East and West Germany. Scand J Public Healt 2013, 41:260-268.
• [19]Huijts T, Eikemo TA, Skalicka V: Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age. Soc Sci Med 2010, 71:1964-1972.
• [20]Brekke KA, Grunfeld LA, Kverndokk S: Asymmetric impacts of transfers for the concentration index: explaining the health equality paradox. HERO: University of Oslo; 2012.
• [21]Van Doorslaer E, Masseria C, Koolman X: Inequalities in access to medical care by income in developed countries. Can Med Assoc J 2006, 174:177-183.
• [22]Clarke PM, Gerdtham UG, Johannesson M, Bingefors K, Smith L: On the measurement of relative and absolute income-related health inequality. Soc Sci Med 2002, 55:1923-1928.
• [23]Clarke P, Smith L, Jenkinson C: Health Inequalities: comparing health inequalities among men aged 18–65 years in Australia and England using the SF-36. Aust Nz J Publ Heal 2002, 26:136-143.
• [24]Gunasekara FI, Carter K, McKenzie S: Income-related health inequalities in working age men and women in Australia and New Zealand. Aust Nz J Publ Heal 2013, 37:211-217.
• [25]Hernandez-Quevedo C, Jones AM, Lopez-Nicolas A, Rice N: Socioeconomic inequalities in health: a comparative longitudinal analysis using the European community household panel. Soc Sci Med 2006, 63:1246-1261.
• [26]Okun MA, Stock WA, Haring MJ, Witter RA: Health and subjective well-being: a meta-analysis. Int J Aging Hum Dev 1984, 19:111-132.
• [27]Connelly JE, Philbrick JT, Smith GR Jr, Kaiser DL, Wymer A: Health perceptions of primary care patients and the influence on health care utilization. Med Care 1989, 27:S99-S109.
• [28]Idler EL, Angel RJ: Self-rated health and mortality in the NHANES-I epidemiologic follow-up-study. Am J Public Health 1990, 80:446-452.
• [29]Wannamethee G, Shaper AG: Self-assessment of health status and mortality in middle-aged British men. Int J Epidemiol 1991, 20:239-245.
• [30]Idler EL, Kasl S: Health perceptions and survival - Do global evaluations of health-status really predict mortality. J Gerontol 1991, 46:S55-S65.
• [31]Idler EL, Kasl SV: Self-ratings of health - Do they also predict change in functional ability. J Gerontol B-Psychol 1995, 50:S344-S353.
• [32]Burström B, Fredlund P: Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Commun H 2001, 55:836-840.
• [33]Gerdtham UG, Johannesson M, Lundberg L, Isacson D: A note on validating Wagstaff and van Doorslaer’s health measure in the analysis of inequalities in health. J Health Econ 1999, 18:117-124.
• [34]Idler EL, Benyamini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997, 38:21-37.
• [35]McCallum J, Shadbolt B, Wang D: Self-rated health and survival: a 7-year follow-up-study of Australian elderly. Am J Public Health 1994, 84:1100-1105.
• [36]Kaplan GA, Camacho T: Perceived health and mortality: a 9-year follow-up of the human-population laboratory cohort. Am J Epidemiol 1983, 117:292-304.
• [37]Eurostat: Description of SILC user database variables: cross-sectional and longitudinal. 2009.
• [38]Kakwani N, Wagstaff A, van Doorslaer E: Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econometrics 1997, 77:87-103.
• [39]Eurostat statistics database. [http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database webcite]
• [40]StataCorp: Stata statistical software. Release 11 edition. College Station, TX: StataCorp LP; 2009.
• [41]Lindeboom M, van Doorslaer E: Cut-point shift and index shift in self-reported health. J Health Econ 2004, 23:1083-1099.
• [42]Delpierre C, Lauwers-Cances V, Datta GD, Lang T, Berkman L: Using self-rated health for analysing social inequalities in health: a risk for underestimating the gap between socioeconomic groups? J Epidemiol Commun H 2009, 63:426-432.