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

Tinna Ásgeirsdóttir,Dagný Ragnarsdóttir

doi:10.1186/1475-9276-12-53

Tinna Ásgeirsdóttir, Dagný Ragnarsdóttir

Open Access

https://doi.org/10.1186/1475-9276-12-53

Copy DOI

Abstract

IntroductionThe 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.MethodsThe 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.ResultsIncome-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.ConclusionsThe 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.

Highlights

The aim of publicly-provided health care is generally to produce health, and to decrease variation in health by socio-economic status
The countries with both the highest mean equivalized disposable household income and individual gross employee cash income are Luxembourg, Iceland and Norway, and their average health is in all instances good
Being unemployed, retired or disabled is positively related to ill-health, and in many countries the same is true for doing housework or being economically inactive for other reasons

Summary

Introduction

The aim of publicly-provided health care is generally to produce health, and to decrease variation in health by socio-economic status. According to the Organization for Economic Co-operation and Development (OECD), health-care expenditures have grown faster than gross domestic product (GDP) in practically a critical manner, hold them up against each other, and compare across nations. An evaluation of this kind is presented here. This view of entitlement has a different appeal regarding different goods, but health is one of the primary desiderata that many feel should not be a part of a society’s broad reward system. It is not the idea to decrease variation in health, but rather, to decrease variation in health by socio-economic status (SES)

Objectives

Methods

Results

Discussion

Conclusion