Sometimes More Equal Than Others: How Health Inequalities Depend on the Choice of Welfare Indicator
A large body of empirical work in recent years has focused on measuring and explaining socioeconomic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by per capita consumption or an asset index. Currently, there is only limited information on how the choice of welfare indicators affects the analysis of health inequalities and the incidence of public spending. The purpose of this paper is to illustrate the potential sensitivity of the analysis of health-related inequalities to how socioeconomic status is measured. Using data from Mozambique, the paper focuses on five key health service indicators and tests whether measured inequality (concentration index) in the five health service variables is different depending on the choice of welfare indicator. The paper shows that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on measured inequality in utilization of health service and on the perceived incidence of public spending. Consequently, we can reach very different conclusions about the "same" issue depending on how we define socioeconomic status. The results call for more clarity and care in the analysis of health-related inequalities and for explicit recognition of the potential sensitivity of findings to the choice of welfare measure. The results also point to the need for more careful research on how different dimensions of socioeconomic status are related, and on the pathways by which these dimensions affect health-related variables.
Summary: | A large body of empirical work in recent
years has focused on measuring and explaining socioeconomic
inequalities in health outcomes and health service use. In
any effort to address these questions, analysts must
confront the issue of how to measure socioeconomic status.
In developing countries, socioeconomic status has typically
been measured by per capita consumption or an asset index.
Currently, there is only limited information on how the
choice of welfare indicators affects the analysis of health
inequalities and the incidence of public spending. The
purpose of this paper is to illustrate the potential
sensitivity of the analysis of health-related inequalities
to how socioeconomic status is measured. Using data from
Mozambique, the paper focuses on five key health service
indicators and tests whether measured inequality
(concentration index) in the five health service variables
is different depending on the choice of welfare indicator.
The paper shows that, at least in some contexts, the choice
of welfare indicator can have a large and significant impact
on measured inequality in utilization of health service and
on the perceived incidence of public spending. Consequently,
we can reach very different conclusions about the
"same" issue depending on how we define
socioeconomic status. The results call for more clarity and
care in the analysis of health-related inequalities and for
explicit recognition of the potential sensitivity of
findings to the choice of welfare measure. The results also
point to the need for more careful research on how different
dimensions of socioeconomic status are related, and on the
pathways by which these dimensions affect health-related variables. |
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