Stecklov, G.: Defining health inequality: why Rawls succeeds where social welfare theory fails. J. Health Econ. 21, 497-513

Institut National d'etudes Démographiques, INRA-Jourdan, Paris, France.
Journal of Health Economics (Impact Factor: 2.58). 06/2002; 21(3):497-513. DOI: 10.1016/S0167-6296(01)00138-2
Source: PubMed


While there has been an important increase in methodological and empirical studies on health inequality, not much has been written on the theoretical foundation of health inequality measurement. We discuss several reasons why the classic welfare approach, which is the foundation of income inequality analysis, fails to provide a satisfactory foundation for health inequality analysis. We propose an alternative approach which is more closely linked to the WHO concept of equity in health and is also consistent with the ethical principles espoused by Rawls [A Theory of Justice. Harvard University Press, Cambridge, MA, 1971]. This approach in its simplest form, is shown to be closely related to the concentration curve when health and income are positively related. Thus, the criteria presented in our paper provide an important theoretical foundation for empirical analysis using the concentration curve. We explore the properties of these approaches by developing policy scenarios and examining how various ethical criteria affect government strategies for targeting health interventions.

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    • "no observed association between income and SAH -and −1 ≤ CI ≤ 1 due to the 2 µ h term. Covariance forms the basis of the measurement of socioeconomic-related inequalities in health, according to the criteria of Wagstaff et al. (1991) and Bommier and Stecklov (2002), among others. "
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    ABSTRACT: Changes in variance, or volatility, over time can be modeled using the approach based on autoregressive conditional heteroscedasticity. Another approach is to model variance as an unobserved stochastic process. Although it is not easy to obtain the exact likelihood function for such stochastic variance models, they tie in closely with developments in finance theory and have certain statistical attractions. This article sets up a multivariate model, discusses its statistical treatment, and shows how it can be modified to capture common movements in volatility in a very natural way. The model is then fitted to daily observations on exchange rates.
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    • "While different methods (including the calculation of odds ratios) have been proposed in the public health literature (Mackenbach and Kunst, 1997), the concentration curve has become the workhorse in most health economic studies. Recently, a number of papers have been published which propose a welfare economic foundation for its use (Wagstaff, 2002; Koolman and van Doorslaer, 2004; Bleichrodt and van Doorslaer, 2006) or advocate alternative approaches (Bommier and Stecklov, 2002; Becker et al., 2005; Abul Naga and Geoffard, 2006; Zheng, 2006; Dias and Jones, 2007; Fleurbaey, 2006b). "
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    ABSTRACT: Inequalities in health and health care are caused by different factors. Measuring "unfair" inequalities implies that a distinction is introduced between causal variables leading to ethically legitimate inequalities and causal variables leading to ethically illegitimate inequalities. An example of the former could be life-style choices, an example of the latter is social background. We show how to derive measures of unfair inequalities in health and in health care delivery from a structural model of health care and health production: "direct unfairness", linked to the variations in medical expenditures and health in the hypothetical distribution in which all legitimate sources of variation are kept constant; "fairness gap", linked to the differences between the actual distribution and the hypothetical distribution in which all illegitimate sources of variation have been removed. These two approaches are related to the theory of fair allocation. In general they lead to different results. We propose to analyse the resulting distributions with the traditional apparatus of Lorenz curves and inequality measures. We compare our proposal to the more common approach using concentration curves and analyse the relationship with the methods of direct and indirect standardization. We discuss how inequalities in health care can be integrated in an overall evaluation of social inequality.
    Journal of Health Economics 09/2008; 28(1):73-90. DOI:10.1016/j.jhealeco.2008.07.016 · 2.58 Impact Factor
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    • "Defining the most appropriate counterfactual scenario to determine when workers would retire in the absence of the health gradient is far from trivial. Bommier and Stecklov (2002) suggest: If equity in health is defined according to a social justice approach, " the health distribution in an ideal equitable society is one where access to health has not been determined by income or socioeconomic status. " Thus, knowing one's health status does not help in predicting a person's income, or vice versa. "
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    ABSTRACT: This study investigates the role of stratification of health and income in the social cost of health-related early retirement, as evidenced in the German Socio-economic Panel (GSOEP). We interpret early retirement as a mechanism to limit work-related declines in health that allows poorer and less healthy workers to maximize the total discounted value of annuities received from Germany’s pay-as-you-go pension system. Investments in new medical technology and better access to existing health services may help to curb the need for early retirement and thus improve efficiency, especially amid population ageing. To value the potential gains, we calibrate an intertemporal model based on ex post predictions from stratified duration regressions for individual retirement timing. We conclude that eliminating the correlation between income and health decline would delay the average age of retirement by approximately half a year, while keeping all workers in the highest of five categories of self assessed health would yield a further delay of up to three years. Had this scenario been realized during our 1992–2005 sample period, we estimate the social costs of early retirement would have been more than 20 percent lower, even without counting the direct social benefits from better health
    Schmollers Jahrbuch 05/2008; DOI:10.3790/schm.132.2.323
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