Lecture 3 - Equity and Equality Flashcards
What are the 4 concepts of equity and equality? Explain them including their policy focus
- Libertarianism; respect to life, liberty and possessions. Policy focus - free market
- Utilitarianism; greatest good for the greatest number. Policy focus - efficiency
- Justice as fairness (Rawlsianism): tolerance inequality only if it benefits the least well-off. Policy focus - social exclusion. Maxi-min principle
- Egalitarianism (Marxism): to each according to their need, from each according to their ability to pay. Policy focus - distribution
Does inequality always mean inequity?
No
e.g. under egalitarianism, high income are giving more money than low income (unequal), but it is equitable
What is horizontal equity?
Equal treatment of equals. People with the same healthcare needs receive the same amount of care.
What is vertical equity?
Unequal treatment of unequals. People in greater need should receive more care.
What is the social welfare function for utilitarianism?
Add up the utility of each individual
WU = ∑N i=1 zi
What is the social welfare function for justice as fairness/Rawlsianism?
Look at who has the lowest utility and maximise the value of that minimum value (maxi-min principle)
WR = [min(zi)]
What is the social welfare function for egalitarianism?
Sum the utility of every individual, taking into account ‘e’ - the maximum amount of inequality you are willing to tolerance to maximise utility
Finding e is very difficult
What is the Gini index? What do 0 and 1 mean?
Measure of income distribution within a group
G=0 is perfect equality (everyone has the same income)
G=1 is maximum inequality
What is a Lorenz curve?
Proportion of total income earned by the bottom x% of the population
y axis - cumulative share of income, 0 to 100%
x axis - percentage of households, 0 to 100%
See notes for graph
How do you calculate the Gini coefficient?
= A/(A+B)
A - area between the line of equality and the Lorenz curve
B - area between the x axis and the Lorenz curve
See notes for graph
What is the Kakwani index? What do positive and negative values mean?
Measure of progressivity of a social intervention
K > 0 is progressive
K < 0 is regressive
How do you calculate the Kakwani index?
Gini coefficient pre-intervention - Gini coefficient post-intervention
What is some country evidence in Asia regarding the progressivity/regressivity of SHI?
- In Asia the better-off tend to pay more for healthcare
- Japan, South Korea and Taiwan have SHI and are slightly regressive
- Hong Kong and Thailand health financing is drawn more from taxation (progressive)
What does the concentration curve plot?
Plots the cumulative % of ill health variable (y-axis, 0 to -1, -1 is least sick) against the cumulative % of population ranked by socioeconomic status (x-axis, 0 to 1, 1 is richest)
See notes for graph
What does it mean if the concentration curve is above the line of equity? What does it mean if the concentration curve is below the line of equity?
Above - ill health concentrated in the poor
Below - ill health concentrated in the rich
See notes for graph
What is a concentration index?
Measures the degree of social-economic inequality in a health variable
How do you calculate the concentration index?
Twice the area between the concentration curve and the line of equity
What is the value of the concentration index when the concentration curve is above the line of equity? Below?
Above - CI < 0, use/need is concentrated in the poor
Below - CI > 0, use/need concentrated in the rich
Can use CI to measure either need or use
How can you use the concentration curve and concentration index to calculate healthcare use?
Switch the y axis to cumulative proportion of healthcare use instead of ill health
What does it mean if the concentration index of need is less than the concentration index of use?
Low income groups use less care than their share of need
How do you calculate horizontal inequity? What do positive values mean? Negative?
HI = CIU - CIN
HI < 0: inequity favours the worse off (worse off use relatively more than they need
HI > 0: inequity favours the better off (worse off use relatively less than they need)
Van Doorslaer et al (2000)
In Europe and the US
- healthcare use is greater in lower income groups
- after controlling for need there is little general evidence of inequity
- general lack of horizontal inequity suggests that health care utilisation is generally related to need not income
O’Donnell et al (2000)
In Asia
- the better off tend to pay more for healthcare
- the better off also tend to receive more healthcare (pro-rich bias)
What is the Libertarian argument for state correction of distributional differences?
- ill health and healthcare need are the result of our free choices (diet, lifestyle, effort at work/school and hence income, how much we spend on healthcare products) or misfortune
- why should we care about others bad luck?
What is the Rawlsian argument for state correction of distributional differences?
- health is influenced by generic and biological factors we can’t control
- state should intervene to ensure the most disadvantaged are as well-off as they can be
- might mean taxing people who work to support those with lower incomes
What is the Egalitarian argument for state correction of distributional differences?
- environments, education, work and income influence health, it is not just our free choices
- we have little control over our social conditions
- social determinents of health provide motivation for greater state involvement
