Abstract
This paper presents new evidence on income-related health inequality and its development over time in Switzerland. We employ the methods lined out in van Doorslaer and Jones (2003) and van Doorslaer and Koolman (2004) measuring health using an interval regression approach to compute concentration indices and decomposing inequality into its determining factors. Nationally representative survey data for 1982, 1992, 1997 and 2002 are used to carry out the analysis. Looking at each of the four years separately the results indicates the usual positive relationship between income and health, but the distribution is among the least unequal in Europe. No clear trend emerges in the evolution of the inequality indices over the two decades. Inequality is somewhat lower in 1982 and 1992 as compared to 1997 and 2002 but the differences are not significant. The most important contributors to health inequality are income, education and activity status, in particular retirement. Regional differences including the widely varying health care supply, by contrast, do not exert any systematic influence.
Highlights
Persistent differences in health and mortality by socio-economic status have long been observed in many countries
The cumulative frequency of Selfassessed health (SAH) is mapped to the empirical distribution of a generic health measure, the Canadian Health Utilities Index Mark III (HUI) which was developed by Feeny et al (2002)
The decomposition method we use allows for the decomposition of total observed income-related health inequality into the contributions of the health elasticity and the inequality by income for all health determinants included in the analysis
Summary
Persistent differences in health and mortality by socio-economic status have long been observed in many countries. One strand of research to which the authors have contributed in previous work has focused on self-reported health and its distribution by income (Van Doorslaer et al 1997), exploiting cross-national variations using comparable data for a number of European countries and the US. Concentration indices and curves were employed to test for differences in the extent to which self-reported health was unequally distributed across income. Van Doorslaer and Koolman (2004) have updated and extended this research using more recent data and new methods for thirteen European Union member states. Both publications reveal consistent health inequalities by income albeit with wide variations between the countries included. In van Doorslaer and Koolman (2004) Portugal in particular, and the UK and Denmark show up with a high degree of income-related inequality, while countries like the Netherlands, Germany, and Italy, Belgium, Spain, Austria and Ireland show a relatively low level of health inequality
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