Equity in health system
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1 Equity in health: Principals and measurements Abdur Razzaque Sarker MHE (Health Economics), MSS (Economics) Health Economics and Financing Research, icddrb and PhD Fellow in Strathclyde University, UK Email: [email protected]
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Transcript of Equity in health system
1
Equity in health: Principals and measurements
Abdur Razzaque SarkerMHE (Health Economics), MSS (Economics)
Health Economics and Financing Research, icddrband
PhD Fellow in Strathclyde University, UKEmail: [email protected]
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What is equity?
Principle of being fair to all, with reference
to a defined and recognized set of values.
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Equity concepts
� Market mechanism is considered fair/Nozick.� Maximising greatest happiness for greatest numbers, but
ignores distributional aspects /Utilitarianism.� Goods are distributed so that the position of the least
well off in society is maximized/ Rawls� Equal shares of a distribution of a commodity which
means equality in health and health care/ Egalitarianism
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Equity in what ?
� Health� Health care delivery � Health care utilization � Health care financing
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Dimensions in Equity
� Vertical equity The principle that says that those who are in different circumstances should be treated differently.
� Horizontal equity
The principle that says that those who are in identical or similar circumstances should be treated equally.
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Measurements
The range
The index of dissimilarity
The slope and relative indices of inequality
The Gini-coefficient
The concentration index
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Criteria to be a good measurement of inequality in health
1. It reflects the experiences of the entire population.
2. It reflects the socioeconomic dimension of health.
3. It is sensitive to changes in the distribution of the population across the socioeconomic groups.
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GINI-COEFFICIENT
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Gini-Coefficient
2 * (Area under diagonal – area under lorenz curve)
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Calculating Gini-Coefficient
Brown’s formula
Index =
Y = Cumulative proportion populationX = Cumulative proportion health or ill-health k = Number of individualsi = Individual and corresponding health in specific position
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Gini-coefficient
Pop Prop pop Cum. Prop.
Pop (X)
Xi-Xi-1
(A)Sickdays
Prop
sickdays Cum prop
sickdays (Y)
Yi+Yi-1 (B)
A*B
1 0.1 0.1 0.1 2 0.02 0.02 0.02 0.0021 0.1 0.2 0.1 4 0.04 0.06 0.08 0.0081 0.1 0.3 0.1 6 0.06 0.12 0.18 0.0181 0.1 0.4 0.1 7 0.07 0.19 0.31 0.0311 0.1 0.5 0.1 9 0.09 0.28 0.47 0.0471 0.1 0.6 0.1 11 0.11 0.39 0.67 0.0671 0.1 0.7 0.1 12 0.12 0.51 0.9 0.091 0.1 0.8 0.1 14 0.14 0.65 1.16 0.1161 0.1 0.9 0.1 15 0.15 0.8 1.45 0.1451 0.1 1 0.1 20 0.2 1 1.8 0.1810 1 100 Sum = 0.704 Gini-coefficient = 1-sum(A*B)= 0.296
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CONCENTRATION INDEX
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A variant of Lorenz curve. Socioeconomic dimension of health is included in the concentration curve.
Concentration curve plots cumulative proportion population (ranked from the poorest to the richest socioeconomic condition) in x-axel against poportion injuries in y-axel.
Concentration curve
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Lorenz CurveLorenz Curve
Lorenz curve plots cumulative proportion population (ranked from the sickest to the healthiest one) in x-axel against poportion health in y-axel.
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Serial Pop Sick days
1 1 102 1 103 1 104 1 105 1 106 1 107 1 108 1 109 1 10
10 1 10Sum 10 100
Equal distribution of sick days
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Lorenz curve with perfect equality
Cumulative proportion populationCu
mu
lative prop
ortion H
ealthy D
ays
20%
40%
60%
80%
100%
20% 40% 60% 80% 100%O
B
C
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Inequal distribution of sickdays
Serial Pop Sickdays
1 1 22 1 43 1 64 1 75 1 96 1 117 1 128 1 149 1 15
10 1 20Total 10 100
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Cumulative proportion population
Cu
mu
lative prop
ortion Q
AL
Ys
Lorenz curve with inequality in QALYs
20%
40%
60%
80%
100%
20% 40% 60% 80% 100%
•
•
•
•
O
B´
B
C
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Cumulative proportion population (ranked from poorest to richest)
Cu
mu
lative prop
ortion sick
days
Concentration curve of sickdays
20%
40%
60%
80%
100%
20% 40% 60% 80% 100%
•
•
•
•
O
B´
B
C
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Concentration Index
2*(area under diagonal – area under concentration curve)
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Calculating concentration index
Pop Prop pop Cum. Prop. Pop
(X)
Xi-Xi-1 (A) Sickdays Prop sickdays
Cum prop
sickdays (Y)
Yi+Yi-1 (B)
A*B
1 (Poorest) 0.1 0.1 0.1 14 0.184 0.184 0.184 0.0181 0.1 0.2 0.1 12 0.158 0.342 0.526 0.0531 0.1 0.3 0.1 10 0.132 0.474 0.816 0.0821 0.1 0.4 0.1 9 0.118 0.592 1.066 0.1071 0.1 0.5 0.1 8 0.105 0.697 1.289 0.1291 0.1 0.6 0.1 7 0.092 0.789 1.487 0.1491 0.1 0.7 0.1 6 0.079 0.868 1.658 0.1661 0.1 0.8 0.1 5 0.066 0.934 1.803 0.181 0.1 0.9 0.1 3 0.039 0.974 1.908 0.1911 (Richest) 0.1 1 0.1 2 0.026 1 1.974 0.197 1 76 1.271 Concentration Index = 1-sum(A*B)= -0.271
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1. It reflects the experiences of the entire population.
2. It reflects the socioeconomic dimension of health.
3. It is sensitive to changes in the distribution of the population across the socioeconomic groups.
Check if Gini-coefficient and concentration index satisfy the following criteria.
