Teresa Bago d'Uva

Measurement of horizontal inequity in health care utilisation using European panel data

Measurement of inequity in health care delivery has focused on the extent to which health care utilisation is or is not distributed according to need, irrespective of income. Studies using cross-sectional data have proposed various ways of measuring and standardizing for need, but inevitably much of the inter-individual variation in needs remains unobserved in cross-sections. This paper exploits panel data methods to improve the measurement by including the time-invariant part of unobserved heterogeneity into the need-standardization procedure. Using latent class hurdle models for GP and specialist visits estimated on 8 annual waves of the European Community Household Panel we compute indices of horizontal equity that partition total income-related variation in use into a need- and a non-need related part, not only for the observed but also for the unobserved but time-invariant component. We also propose and compare a more conservative index of horizontal inequity to the conventional statistic. We find that many of the cross-country comparative results appear fairly robust to the panel data test, although the panel-based methods lead to significantly higher estimates of horizontal inequity for most countries. This confirms that better estimation and control for need often reveals more pro-rich distributions of doctor utilisation.

Slipping Anchor? Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity

We propose tests of the two assumptions under which anchoring vignettes identify heterogeneity in reporting of categorical evaluations. Systematic variation in the perceived difference between any two vignette states is sufficient to reject vignette equivalence. Response consistency—the respondent uses the same response scale to evaluate the vignette and herself—is testable given sufficiently comprehensive objective indicators that independently identify response scales. Both assumptions are rejected for reporting of cognitive and physical functioning in a sample of older English individuals, although a weaker test resting on less stringent assumptions does not reject response consistency for cognition.

Health care utilisation in Europe: New evidence from the ECHP

The ECHP is used to analyse health care utilisation care in Europe. We estimate a new latent class hurdle model for panel data and compare it with the latent class NegBin model and the standard hurdle model. Latent class specifications outperform the standard hurdle model and the latent class hurdle model reveals income effects that are masked in the NegBin model. For specialist visits, low users are more income elastic than high users and the probability of using care is more income elastic than the conditional number of visits. The effects of income on total use of GPs are mostly negative or insignificant but positive elasticities are found for Austria, Greece and, to a greater extent, Portugal. On the whole, richer individuals tend to use more specialist care, especially in Portugal, Ireland, Finland, Greece and Austria. Features of the health care systems of these countries may contribute to the observed inequities.

Health and Wealth: Empirical Findings and Political Consequences

Abstract There is increasing concern that equity in health and health care in Europe may suffer as a result of the expansion of the European Union and the ageing of its populations. This article reviews the findings of the ‘‘ECuity III’’ project: a network of European health economists who have investigated socioeconomic inequalities in health and health care. In order to help inform the policy debate about how to secure health equity in our ageing European societies, the project pays particular attention to the key decisions about income, health and health care in age groups around the retirement age, as these prove to be crucial for a better understanding of cross-country differences in inequalities.

Time to Drop Time-to-Death? Unraveling the Determinants of LTC Spending in the Netherlands

A better understanding of what drives long term care (LTC) expenditures is important for all countries with aging populations. We employ unique new data sources to analyze the determinants of LTC spending in the Netherlands. First, we use two-part models, to analyze institutional LTC and homecare expenditures for the entire 55+ population, conditioning not only on age, sex, time-to-death (TTD), but also on cause-of-death and co-residence status. These have profound effects. Those living alone, as well as those who deceased from diabetes, mental illness, stroke, diseases of the respiratory or digestive system have higher LTC expenditures, while a neoplasm death resulted in lower expenditures. Secondly, we examine homecare expenditures among a sample of non-institutionalized individuals conditioning, additionally, on morbidity and disability. Finally, we reconsider the roles of age and TTD, when controlling for the most important determinants of LTC use - morbidity, disability and co-residence - andillustrate their relevance for forecasting LTC expenditures. Our analysis reveals that TTD is not a predictor of homecare expenditures when disability is controlled for, while age and co-residence are. We therefore conclude that it is time to drop time-to-death from LTC expenditure models as it merely acts as a proxy for disability status.

Who Can Predict Their Own Demise? Accuracy of Longevity Expectations by Education and Cognition

Biased longevity expectations will lead to suboptimal decisions regarding saving, retirement, annuitization and health, with consequences for wellbeing in old age. Systematic differences in the accuracy of longevity expectations may partly explain heterogeneity in economic behaviour by education and cognitive functioning. Analysis of eight waves of the US Health and Retirement Study reveals that individuals with lower levels of education and cognitive functioning report survival probabilities that are less accurate in predicting their in-sample mortality. There is little evidence that the gradients in the veracity of expectations are due to the less educated and cognitively able responding less to changes in objective mortality risks. However, high school dropouts and the least cognitively able report survival probabilities that are less stable and display greater un explained variability. These disadvantaged groups appear to be less confident in their longevity beliefs, which is justified given that their expectations are less accurate.