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Analyzing Health Equity Using Household Survey Data

Analyzing Health Equity Using Household Survey Data. Lecture 13 Explaining Socioeconomic-Related Health Inequality: Decomposition of the Concentration Index. Decomposition of the Concentration Index. For any linear additive explanatory model of ‘ health ’ (y) such as :

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Analyzing Health Equity Using Household Survey Data

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  1. Analyzing Health Equity Using Household Survey Data Lecture 13 Explaining Socioeconomic-Related Health Inequality: Decomposition of the Concentration Index “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  2. Decomposition of the Concentration Index For any linear additive explanatory model of ‘health’ (y) such as : the concentration index of y can be decomposed (Wagstaff et al 2003): where  is the mean of y, is the mean of xk, Ck is the concentration index for xk , GCε is the generalized concentration index for the error term, and ηκ is the elasticity of y with respect to xk . “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  3. Age-sex standardization through decomposition The indirectly standardized concentration index (CIS) can be obtained by subtracting the contributions of all standardizing variables (s) from the unstandardized concentration index (Van Doorslaer et al, 2004): “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  4. Decomposition of Concentration Index for Height-for-Age z-Scores of kids<10 Years, Vietnam Aggregate contributions “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  5. Magnitudes of contributions The contribution of variable xk to income-related health inequality is given by and is larger: • The greater is the elasticity of health in relation to the variable (ηκ) • The more unequally is the variable distributed in relation to income (Ck) “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  6. Detailed decomposition of concentration index for HAZ-Scores in Vietnam

  7. Decomposition of income-related health inequality in Europe

  8. Decomposition of change in the concentration index - Oaxaca Applying Oaxaca-type decomposition to the difference between the concentration indices of two populations: i.e. a sum of the differences in the - CIs for determinants k weighted by their elasticities - elasticities weighted by their respective CIs - generalised CIs of the residuals Of course, the weights could be reversed

  9. Decomposition of increase in inequality in child HAZ-scores in Vietnam 1993-98 “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  10. Decomposition of change in the concentration index – total differential To identify the contribution of the change in each component of the elasticity, take the total differential of the decomposed CI: “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  11. Decomposition of Change in HAZ Concentration Index of kids <10 Years, Vietnam 1993–98

  12. Oaxaca method can be used to explain cross-country differences in income-related health inequality • Netherlands has lowest income-related health inequality • Define ‘excess’ inequality of each country relative to the Netherlands • Compute contribution of each factor to ‘excess’ income-related health inequality “Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

  13. Contribution of each factor to ‘excess’ income-related health inequality relative to the Netherlands

  14. Conclusions • Decomposition is useful explanatory tool for partitioning inequality • Contributions can be further decomposed into elasticity of health and inequality of determinants • Oaxaca-type decomposition useful for explaining differences or changes • Limitations: • Linearity of underlying model • Explanatory model usually does not allow for causal interpretation

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