Advertisement

Health Status Adjustment and Income-Related Inequality in Health Care Delivery

  • Alex Y. Chen
  • José J. Escarce
Article

Abstract

The literature on equity in health care delivery agrees that adjusting for “medical need” is a necessary component in assessing whether the delivery of care is equitable, that is, whether it varies with ability to pay. To date, most studies measuring income-related inequality in the delivery of health care have employed crude measures of health status to adjust for medical need and have acknowledged this as a limitation. This study examines how using more complete health status measures affects estimates of income-related inequality for U.S. adults. The findings suggest that previous studies may understate the extent of pro-rich inequality.

Keywords

MEPS inequality health status adjustment 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Blough, D., Madden, C., and Hornbrook, M., “Modeling risk using generalized linear models,” Journal of Health Economics 18(2), 153–171, 1999.PubMedGoogle Scholar
  2. 2.
    Christiansen, T., “Equity in the finance and delivery of health care in Denmark,” in E. van Doorslaer, A. Wagstaff, and F. Rutten (eds.), Equity in the finance and delivery of health care: An international perspective,” Oxford University Press, Oxford, 1993.Google Scholar
  3. 3.
    Cohen, J., Monheit, A., Beauregard, K., et al., “The Medical Expenditure Panel Survey: a national health information resource,” Inquiry 33(4), 373–389, 1996/97.Google Scholar
  4. 4.
    Efron, B. and Tibshirani, R., An introduction to the bootstrap, Chapman and Hall, New York, 1993.Google Scholar
  5. 5.
    Escarce, J. and Puffer, F., “Black-white differences in the use of medical care by the elderly: A contemporary analysis,” in L.G. Martin, and D.J. Soldo (eds.), Racial and ethnic differences in the health of older Americans, National Academy Press, Washington, DC, pp. 183–209, 1997.Google Scholar
  6. 6.
    Gross, D., Alecxih, L., Gibson, M., Corea, J., Caplan, C., and Brangan, N., “Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries,” Health Services Research 34(1 Pt 2), 241–254, 1999.PubMedGoogle Scholar
  7. 7.
    Kikano, G., Schiaffino, M., and Zyzanski, S., “Medical decision making and perceived socioeconomic class,” Archives of Family Medicine 5(5), 267–270, 1996.PubMedGoogle Scholar
  8. 8.
    Le Grand, J., “The distribution of public expenditure: the case of healthcare,” Economica 45, 125–142, 1978.Google Scholar
  9. 9.
    Manning, W., Newhouse, J., Duan, N., Keeler, E., Leibowitz, A., and Marquis, M., “Health insurance and the demand for medical care: Evidence from a randomized experiment,” American Economic Review 77, 251–277, 1987.PubMedGoogle Scholar
  10. 10.
    Manning, W., Morris, C., Newhouse, J., et al., A two-part model of the demand for medical care: Preliminary results from the Health Insurance Study,” in Health, economics, and health economics, J. van der Gaag and M. Perlman (eds.), North Holland, Amsterdam, pp. 103–123, 1981.Google Scholar
  11. 11.
    Manning, W. and Mullahy, J., “Estimating log models: To transform or not to transform?” Journal of Health Economics 20(4), 461–494, 2001.PubMedGoogle Scholar
  12. 12.
    MEPS HC-020: 1997, “Full year consolidated data filedocumentation,” Washington, D.C.: Agency for Healthcare Research and Quality, 2001. (Accessed June 20, 2002; at http://meps.ahrq.gov/Data_Pub/HC_FYData97.htm.)
  13. 13.
    MEPS HC-028: 1998, “Full year consolidated data file documentation,” Washington, D.C.: Agency for Healthcare Research and Quality, 2001 (Accessed June 20, 2002, at http://meps.ahrq.gov/Data_Pub/HC_FYData98.htm.)
  14. 14.
    Miller, B., Campbell, R., Furner, S., et al., “Use of medical care by African American and White older persons: comparative analysis of three national data sets,” Journal of Gerontology Social Sciences52(6), S325–S335, 1997.Google Scholar
  15. 15.
    Mutchler, J. and Burr, J., “Racial differences in health and health care service utilization in later life: The effect of socioeconomic status,” Journal of Health and Social Behavior 32(4), 342–356, 1991.PubMedGoogle Scholar
  16. 16.
    Poisal, J., Murray, L., Chulis, G., and Cooper, B., “Prescription drug coverage and spending for Medicare beneficiaries,” Health Care Financing Review 20(3), 15–27, 1999.PubMedGoogle Scholar
  17. 17.
    Poisal, J. and Murray, L., “Growing differences between Medicare beneficiaries with and without drug coverage,” Health Affairs (Millwood) 20(2), 74–85, 2001.Google Scholar
  18. 18.
    Pourat, N., Rice, T., Kominski, G., and Snyder, R., “Socioeconomic differences in Medicare supplemental coverage,” Health Affairs (Milwood) 19(5), 186–196, 2000.Google Scholar
  19. 19.
    Studdert, D.M., Bhattacharya, J., Schoenbaum, M., Warren, B., and Escarce, J.J., “Personal choices of health plans by managed care experts,” Medical Care 40(5), 375–386, 2002.PubMedGoogle Scholar
  20. 20.
    van Doorslaer, E., Wagstaff, A., “Equity in the delivery of health care: some international comparisons,” Journal of Health Economics 11, 389–411, 1992.PubMedGoogle Scholar
  21. 21.
    van Doorslaer, E. and Wagstaff, A., van der Burg, H., et al., “Equity in the delivery of health care in Europe and the US,” Journal of Health Economics 19, 553–583, 2000.PubMedGoogle Scholar
  22. 22.
    Wagstaff, A. and van Doorslaer, E., “Equity in health care finance and delivery,” in Handbook of health economics, A.J. Culyer and J.P. Newhouse (eds.), Vol. 1, Elsevier Science, New York, pp. 1803–1862, 2000.Google Scholar
  23. 23.
    Wagstaff, A., van Doorslaer, E., and Paci, P., “On the measurement of horizontal inequity in the delivery of health care,” Journal of Health Economics 10, 169–205, 1991.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Division of Research on Children, Youth, and FamiliesChildren’s Hospital Los AngelesLos Angeles
  2. 2.Division of General Internal Medicine and Health Services ResearchDavid Geffen School of Medicine at UCLALos Angeles, California; RAND Health, Santa Monica

Personalised recommendations