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Education-related Inequity in Health Care with Heterogeneous Reporting of Health

Author

Listed:
  • Teresa Bago d'Uva

    (Erasmus University Rotterdam)

  • Maarten Lindeboom

    (VU University Amsterdam)

  • Owen O'Donnell

    (Erasmus University Rotterdam, and University of Macedonia, Thessaloniki, Greece)

  • Eddy van Doorslaer

    (Erasmus University Rotterdam, the Netherlands)

Abstract

This discussion paper resulted in a publication in the 'Journal of the Royal Statistical Society' , Series A, 2011, 2011, 174, 639–664. Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in health care utilisation. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of doctor visits in the direction of inequality favouring the better educated. There is a further, and typically larger, shift the same direction when correction is made for the tendency of the better educated to rate their health more negatively.

Suggested Citation

  • Teresa Bago d'Uva & Maarten Lindeboom & Owen O'Donnell & Eddy van Doorslaer, 2010. "Education-related Inequity in Health Care with Heterogeneous Reporting of Health," Tinbergen Institute Discussion Papers 10-122/3, Tinbergen Institute.
    • Handle: RePEc:tin:wpaper:20100122
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    as
    1. Arie Kapteyn & James P. Smith & Arthur van Soest, 2009. "Work Disability, Work, and Justification Bias in Europe and the U.S," NBER Working Papers 15245, National Bureau of Economic Research, Inc.
    2. repec:adr:anecst:y:2005:i:79-80:p:25 is not listed on IDEAS
    3. Rainer Winkelmann, 2004. "Health care reform and the number of doctor visits-an econometric analysis," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 455-472.
    4. Hans van Kippersluis, & Owen O’Donnell & Eddy van Doorslaer, 2011. "Long-Run Returns to Education: Does Schooling Lead to an Extended Old Age?," Journal of Human Resources, University of Wisconsin Press, vol. 46(4), pages 695-721.
    5. repec:cup:apsrev:v:98:y:2004:i:01:p:191-207_00 is not listed on IDEAS
    6. Paul V. Grootendorst, 1995. "A comparison of alternative models of prescription drug utilization," Health Economics, John Wiley & Sons, Ltd., vol. 4(3), pages 183-198, May.
    7. Arie Kapteyn & James P. Smith & Arthur van Soest, 2007. "Vignettes and Self-Reports of Work Disability in the United States and the Netherlands," American Economic Review, American Economic Association, vol. 97(1), pages 461-473, March.
    8. James P. Smith, 2007. "The Impact of Socioeconomic Status on Health over the Life-Course," Journal of Human Resources, University of Wisconsin Press, vol. 42(4).
    9. Sherry Glied & Adriana Lleras-Muney, 2008. "Technological innovation and inequality in health," Demography, Springer;Population Association of America (PAA), vol. 45(3), pages 741-761, August.
    10. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375, March.
    11. Adriana Lleras-Muney, 2005. "The Relationship Between Education and Adult Mortality in the United States," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 189-221.
    12. Adriana Lleras-Muney & Frank R. Lichtenberg, 2010. "Are the More Educated More Likely to Use New Drugs?," NBER Chapters, in: Contributions in Memory of Zvi Griliches, pages 671-696, National Bureau of Economic Research, Inc.
    13. Philip Oreopoulos, 2006. "Estimating Average and Local Average Treatment Effects of Education when Compulsory Schooling Laws Really Matter," American Economic Review, American Economic Association, vol. 96(1), pages 152-175, March.
    14. Dreze, Jean & Sen, Amartya, 2002. "India: Development and Participation," OUP Catalogue, Oxford University Press, edition 2, number 9780199257492.
    15. James Smith & Raynard Kington, 1997. "Demographic and economic correlates of health in old age," Demography, Springer;Population Association of America (PAA), vol. 34(1), pages 159-170, February.
    16. King, Gary & Wand, Jonathan, 2007. "Comparing Incomparable Survey Responses: Evaluating and Selecting Anchoring Vignettes," Political Analysis, Cambridge University Press, vol. 15(1), pages 46-66, January.
    17. Frijters, Paul & Haisken-DeNew, John P. & Shields, Michael A., 2005. "The causal effect of income on health: Evidence from German reunification," Journal of Health Economics, Elsevier, vol. 24(5), pages 997-1017, September.
    18. O'Donnell, Owen & Propper, Carol, 1991. "Equity and the distribution of U.K. National Health Service resources," Journal of Health Economics, Elsevier, vol. 10(2), pages 247-249, July.
    19. Arie Kapteyn & James P. Smith & Arthur van Soest, 2009. "Work Disability, Work, and Justification Bias in Europe and the U.S," NBER Working Papers 15245, National Bureau of Economic Research, Inc.
    20. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    21. Gurmu, Shiferaw, 1998. "Generalized hurdle count data regression models," Economics Letters, Elsevier, vol. 58(3), pages 263-268, March.
    22. Datta Gupta, Nabanita & Kristensen, Nicolai & Pozzoli, Dario, 2010. "External validation of the use of vignettes in cross-country health studies," Economic Modelling, Elsevier, vol. 27(4), pages 854-865, July.
    23. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    24. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    25. John Bound, 1991. "Self-Reported Versus Objective Measures of Health in Retirement Models," Journal of Human Resources, University of Wisconsin Press, vol. 26(1), pages 106-138.
    26. repec:dau:papers:123456789/10510 is not listed on IDEAS
    27. Börsch-Supan, Axel & Hank, Karsten & Jürges, Hendrik, 2005. "New Comprehensive and International View on Ageing: The Survey of Health, Ageing and Retirement in Europe," MEA discussion paper series 05075, Munich Center for the Economics of Aging (MEA) at the Max Planck Institute for Social Law and Social Policy.
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    Cited by:

    1. Brilleman, Samuel L. & Gravelle, Hugh & Hollinghurst, Sandra & Purdy, Sarah & Salisbury, Chris & Windmeijer, Frank, 2014. "Keep it simple? Predicting primary health care costs with clinical morbidity measures," Journal of Health Economics, Elsevier, vol. 35(C), pages 109-122.
    2. Chen, Linkun & Clarke, Philip M. & Petrie, Dennis J. & Staub, Kevin E., 2021. "The effects of self-assessed health: Dealing with and understanding misclassification bias," Journal of Health Economics, Elsevier, vol. 78(C).
    3. Richard Layte & Anne Nolan, 2015. "Income-related inequity in the use of GP services by children: a comparison of Ireland and Scotland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 489-506, June.
    4. Caroli, Eve & Weber-Baghdiguian, Lexane, 2016. "Self-reported health and gender: The role of social norms," Social Science & Medicine, Elsevier, vol. 153(C), pages 220-229.
    5. Flavia Cristina Drumond Andrade & Jeenal Deepak Mehta, 2018. "Increasing educational inequalities in self-rated health in Brazil, 1998-2013," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-13, April.
    6. Nicole Black & David W. Johnston & Martin Knapp & Michael A. Shields & Gloria H.Y. Wong, 2024. "Horizontal inequity in the use of mental healthcare in Australia," Papers 2024-14, Centre for Health Economics, Monash University.
    7. Pfarr, Christian & Schmid, Andreas & Schneider, Udo, 2011. "Reporting Heterogeneity in Self-Assessed Health among Elderly Europeans: The Impact of Mental and Physical Health Status," MPRA Paper 29900, University Library of Munich, Germany.
    8. Knott, R. & Lorgelly, P. & Black, N. & Hollingsworth, B., 2016. "Differential item functioning in the EQ-5D: An exploratory analysis using anchoring vignettes," Health, Econometrics and Data Group (HEDG) Working Papers 16/14, HEDG, c/o Department of Economics, University of York.
    9. Bonsang, Eric & Caroli, Eve & Garrouste, Clémentine, 2021. "Gender heterogeneity in self-reported hypertension," Economics & Human Biology, Elsevier, vol. 43(C).
    10. Laura Rossouw & Teresa Bago d’Uva & Eddy Doorslaer, 2018. "Poor Health Reporting? Using Anchoring Vignettes to Uncover Health Disparities by Wealth and Race," Demography, Springer;Population Association of America (PAA), vol. 55(5), pages 1935-1956, October.
    11. Layte, Richard & Nolan, Anne, 2013. "Income-Related Inequity in the Use of GP Services: A Comparison of Ireland and Scotland," Papers WP454, Economic and Social Research Institute (ESRI).
    12. Thomson, Michael, 2019. "Who had access to doctors before and after new universal capitated subsidies in New Zealand?," Health Policy, Elsevier, vol. 123(8), pages 756-764.
    13. Denzil G. Fiebig & Kees van Gool & Jane Hall & Chunzhou Mu, 2021. "Health care use in response to health shocks: Does socio‐economic status matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3032-3050, December.
    14. Geraci Andrea & Fabbri Daniele & Monfardini Chiara, 2018. "Testing Exogeneity of Multinomial Regressors in Count Data Models: Does Two-stage Residual Inclusion Work?," Journal of Econometric Methods, De Gruyter, vol. 7(1), pages 1-19, January.
    15. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    16. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    17. Black, Nicole & Johnston, David W. & Shields, Michael A. & Suziedelyte, Agne, 2017. "Who provides inconsistent reports of their health status? The importance of age, cognitive ability and socioeconomic status," Social Science & Medicine, Elsevier, vol. 191(C), pages 9-18.
    18. Knott, Rachel J. & Lorgelly, Paula K. & Black, Nicole & Hollingsworth, Bruce, 2017. "Differential item functioning in quality of life measurement: An analysis using anchoring vignettes," Social Science & Medicine, Elsevier, vol. 190(C), pages 247-255.
    19. Hanna Grol-Prokopczyk & Emese Verdes-Tennant & Mary McEniry & Márton Ispány, 2015. "Promises and Pitfalls of Anchoring Vignettes in Health Survey Research," Demography, Springer;Population Association of America (PAA), vol. 52(5), pages 1703-1728, October.
    20. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.

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    More about this item

    Keywords

    health care; health; equity; reporting heterogeneity; vignettes;
    All these keywords.

    JEL classification:

    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • C42 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Survey Methods
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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