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Using STATA 10.0 for Health Equity Analysis

Using STATA 10.0 for Health Equity Analysis. Rachid Janta Vuthiphan Wongmongkol 4/12/2008 IHPP Meeting Room. Outline of presentation. Lecture Session Definition of Health Equity Difference of Health Inequity and Health Inequality Determinants and Dimensions of health equity

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Using STATA 10.0 for Health Equity Analysis

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  1. Using STATA 10.0 for Health Equity Analysis Rachid Janta Vuthiphan Wongmongkol 4/12/2008 IHPP Meeting Room

  2. Outline of presentation • Lecture Session • Definition of Health Equity • Difference of Health Inequity and Health Inequality • Determinants and Dimensions of health equity • Health Financing and data sources • Lorenz Curve • Gini coefficient • Technical Session • basic technique on how to using STATA for equity analyses

  3. Definition of Health Equity The International Society for Equity in Health (ISEqH) defined equity in health as “the absence of systematic and potentially remediable differences in one or more aspects of health across populations or population subgroups defined socially, economically, demographically, or geographically”

  4. Difference of inequity and inequality • Health inequalities are differences in health that are “avoidable,” “unjust, and unfair” Whitehead 1990

  5. Determinants of Health Inqualities Seven Determinants of Health Inequalities 1. Natural, biological variation 2. Differential health-damaging behavior that is freely chosen 3. Differential health-promoting behavior that is freely chosen 4. Differential health-damaging or health-promoting behavior, where choices are restricted 5. Differential exposure to unhealthy, stressful conditions (home, work, etc…) 6. Inadequate access to basic social and essential health services 7. Health-related social mobility Generally perceived as unavoidable or fair Generally perceived as avoidable or unfair

  6. Example of Inequality An old man has OP visit 10 time/year VS A young man has OP visit 3 time/year Should this be considered as; - inequality? - equity?

  7. Inequality of Physician Distribution Worldwide

  8. Vertical and horizontal equity • Horizontal equity applies to people in the same status or situation, and people who are alike should be treated in the same fashion, • in other words, equal treatment for equal need. • Vertical equity focuses on the difference between individuals or groups of people, and people who are unlike in relevant respects (e.g. income, health needs), and states that the differences should be treated differently in a just way.

  9. Dimensions and Determinants of Health Equity

  10. Data requirements for health equity analysis

  11. Lorenz Curve • Lorenz curve is a graphical representation of the proportionality of a distribution (the cumulative percentage of the values). It was developed by Max O. Lorenz in 1905 for representing income distribution.

  12. Lorenz Curve

  13. Gini Coefficient Note: Gini Coefficient is a tool for measuring inequality of income. The value of Gini coefficient ranges from 0 to 1. A low Gini coefficient indicates more equal income or wealth distribution, while a high Gini coefficient demonstrates more unequal distribution.

  14. Gini Coefficient

  15. The Kakwani index • is defined as twice the area between the concentration curve of health payment and the Lorenz curve of household income. • The value of the Kakwani index ranges from -2 to 1. • A negative Kakwani index value indicates the regressive nature of health care payments. • In contrast, a positive value indicates the progressive nature of health care payments.

  16. The concentration curve and index • The concentration curve graphs on the x-axis the cumulative percentage of the sample ranked by living standards, beginning with the poorest, and on the y-axis the cumulative percentage of the health service use corresponding to each cumulative percentage of the distribution of the living standard variable. • The concentration index is a means of quantifying the degree of income-related inequality within a specific health variable, for example, health service use, and government health subsidies.

  17. The concentration index • is defined as twice the area between the concentration curve and the line of equality (the 45-degree line running from the bottom-left corner to the top-right). • In the case where there is no income-related inequality, the concentration index is zero. • The index takes a negative value when the concentration curve lies above the 45-degree line of equality, indicating disproportionate concentration of health service use or other health variables among the poor, and a positive value when it lies below the 45-degree line of equality.

  18. Selected concentration curves of ambulatory service use among different types of health facilities in 2003

  19. Household equivalence scale • Equivalence scale (eh) = (Ah + 0.5Kh)0.75, where A (K) is the no. of adults (kids) in the household • OECD-modified equivalence scale Oecdscale = 1 +(hhsize-1 - kids)* 0.5 + (kids*0.3)

  20. The incidence of catastrophic health payments in 2000 and 2002 Note:Catastrophic health expenditure refers to household out-of-pocket payments for health over 10% of household income or expenditure

  21. Resources WBI “OVWL” book – http://siteresources.worldbank.org/INTPAH/Resources/Publications/459843-1195594469249/HealthEquityFINAL.pdf

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