Inequality In Health Care

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This essay reviews a selection of the literature on healthcare-related inequalities, with the aim of illuminating how we can differentiate between fair and unfair, and between avoidable and unavoidable, inequalities in health. This essay also reviews some of the more common methods used to measure healthcare inequalities and discusses their limitations. Some policy considerations are provided at the end. In a society, inequalities in health outcomes, healthcare access and healthcare utilisation are caused by a myriad of factors. In order to appreciate whether an inequality is fair or unfair, and avoidable or unavoidable, we should avail ourselves to the approach proposed by Fleurbaey and Schokkaert (2009). The authors suggest that we start with a “structural model” that describes the whole social context in which a utility-maximising individual makes decisions, subject to a budget constraint. This budget constraint is determined by a range of market, insurance and economic factors: the general price level, tax levels, out-of-pocket payments, insurance coverage and insurance premiums. Individuals have a health production function that depends on factors like medical care, lifestyle choices (for instance nutrition and exercise regimes), genetic endowments, information access, socioeconomic status, and random shocks. In the Fleurbaey-Schokkaert framework, utility-maximisation depends on factors that depend on the individual’s own choice (such as lifestyle factors), as well as factors beyond the individual’s control (random shocks and genetic endowments). Inequalities arising from factors within an individual’s control are deemed “fair”. Conversely, other factors like genetic endowments and socioeconomic status are typically thought... ... middle of paper ... ...ogeneity is addressed by the measurement technique. For instance Dias (2009, 2010) and Trannoy et. al. (2010) aim to model the error term in their econometric techniques to account for unobserved individual efforts and childhood experiences. Thirdly, the characteristics of the health variables used in the measurement technique matters as well. For instance Erreygers and van Ourti (2010) show how the logical consistency of the CI can be influenced by the nature of the health variable (bounded/ unbounded and scale of the variable). In conclusion, measurement of health inequalities is definitely possible, however achieving good quality estimates requires good knowledge of the technique and behavior of the health variables. Furthermore the degree to which we have accurately measured unfair health inequalities depends on the quality of our moral and ethical judgments.

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