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Session: Disparities
Room: Helsinki Hall
Time: Fri 11:45-13:00

Presenter: Silvana Robone (Centre for Health Economics, University of York. )

Abstract

The release of the World Health Report 2000 has brought to the fore the concept of responsiveness, both as an explicit policy goal and as an indicator of health system performance. Despite the growing attention it has received in the economic literature, the links between responsiveness and the extensive literature on health inequalities have not been made explicit. This paper narrows this gap by using data from the World Health Survey to undertake a cross-country analysis of inequality in health system responsiveness. We focus our attention on European countries.

In order to fully respect the intrinsically ordinal nature of key domains of responsiveness, inequality measurement is based on a median-based index, following Alison and Foster (2004) and Abul Naga and Yalcin (2008). This measurement is complemented with analysis of polarisation in the distribution of responsiveness across countries, based on the measures proposed in Apouey (2007) for discrete and ordinal data. Anchoring vignettes are used to account for systematic reporting heterogeneity, ensuring cross-country comparability of responsiveness.

Regardless of differences in life-expectancy, income per-capita and human development of the countries analysed, the computed inequality index shows a strikingly low dispersion around the mean across countries. For example, in the domain of “waiting times”, the inequality indices are centred around a mean value of 0.32, with a coefficient of variation between countries of around 0.17. Systematic reporting heterogeneity does not seem to be the underlying factor explaining this small variation. Once anchoring vignettes are used to account for reporting behaviour, the values of the inequality index for the countries in the dataset become even closer, with a coefficient of variation of around 0.09.

The absolute size of countries’ inequality in responsiveness depends on the parameterisation of the inequality index. Placing a greater weight on inequalities affecting those at the bottom of the income distribution leads to a sizable increase in the magnitude of the measured inequality, but not to a rise in the coefficient of variation of the inequality index across countries. Polarisation and inequality in health system responsiveness are highly and positively correlated (correlation coefficients of around 0.9), but the values of the polarisation measure are in general more dispersed around the median than those of the inequality index.

Key Terms

Anchoring Vignettes, Cross-country Comparison, Health System Responsiveness, Inequality, Polarisation

Authors:

Andrew M. Jones (University of York. Department of Economics and Related Studies) , Nigel Rice (University of York. Centre for Health Economics) , Silvana Robone (University of York. Centre for Health Economics) , Pedro Rosa Dias (Centre for Health Economics. University of York) and Peter C. Smith (Imperial College London)

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