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Local inequality and departures from publicly provided health care in Canada

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  • Maripier Isabelle
  • Mark Stabile

Abstract

This paper examines the relationship between changes in income inequality and the provision of resources in a health care system (the public‐private mix). Specifically, we investigate whether increases in income inequality, as separate from overall income levels and growth, have changed the availability of both private clinics and privately financed physicians in a context where the dominant market player is the public system. Our findings provide reasonable evidence that increases in income inequality have led to substantial increases in both. We find that moving from median level of inequality across neighborhoods to the top 1% level of inequality increases the probably of a private clinic by 40% and the probability of having physicians who have opted out of the public system by 170%.

Suggested Citation

  • Maripier Isabelle & Mark Stabile, 2020. "Local inequality and departures from publicly provided health care in Canada," Health Economics, John Wiley & Sons, Ltd., vol. 29(9), pages 1031-1047, September.
  • Handle: RePEc:wly:hlthec:v:29:y:2020:i:9:p:1031-1047
    DOI: 10.1002/hec.4117
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    References listed on IDEAS

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    1. Propper, Carol, 1993. "Constrained choice sets in the U.K. demand for private medical insurance," Journal of Public Economics, Elsevier, vol. 51(3), pages 287-307, July.
    2. Kristov, Lorenzo & Lindert, Peter & McClelland, Robert, 1992. "Pressure groups and redistribution," Journal of Public Economics, Elsevier, vol. 48(2), pages 135-163, July.
    3. Humphrey, Charlotte & Russell, Jill, 2004. "Motivation and values of hospital consultants in south-east England who work in the national health service and do private practice," Social Science & Medicine, Elsevier, vol. 59(6), pages 1241-1250, September.
    4. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
    5. Lupu, Noam & Pontusson, Jonas, 2011. "The Structure of Inequality and the Politics of Redistribution," American Political Science Review, Cambridge University Press, vol. 105(2), pages 316-336, May.
    6. Terence C. Cheng & Guyonne Kalb & Anthony Scott, 2018. "Public, private or both? Analyzing factors influencing the labour supply of medical specialists," Canadian Journal of Economics, Canadian Economics Association, vol. 51(2), pages 660-692, May.
    7. Epple, Dennis & Romano, Richard E, 1996. "Public Provision of Private Goods," Journal of Political Economy, University of Chicago Press, vol. 104(1), pages 57-84, February.
    8. Stabile, Mark & Isabelle, Maripier, 2018. "Rising inequality and the implications for the future of private insurance in Canada," Health Economics, Policy and Law, Cambridge University Press, vol. 13(3-4), pages 406-432, July.
    9. Joseph P. Newhouse, 1992. "Medical Care Costs: How Much Welfare Loss?," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 3-21, Summer.
    10. Kurt R. Brekke & Lars Sørgard, 2007. "Public versus private health care in a national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(6), pages 579-601, June.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 21st September 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-09-21 11:00:06

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