Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

The upcoming ASHE conference seeks to focus in part on the ?Equity? of ?Healthcare?, yet no systematic study of U.S. equity in the finance and delivery of healthcare has been conducted since the analysis of 1987 data in Wagstaff et al. (Journal of Health Economics, 1999). This gap in the literature is particularly remarkable given that the U.S. has a complex system for financing and delivering healthcare, combining an array of public and private components. The proposed paper seeks to fill this gap by applying the methodology of Wagstaff, van Doorslaer, and colleagues to more recent data from the Medical Expenditure Panel Survey. The data have been aligned to the National Medical Expenditure Accounts, and a full array of tax expenditures has been simulated. The analysis will report sources of financing by deciles of equivalent income along with Kakwani concentration indices, thereby facilitating international comparisons. The analysis will also present results regarding equity in the delivery of healthcare, both for measures of access and for all medical care received (valued using both total expenditures and total charges). Finally, the paper will examine the sensitivity of equity measures for delivery to alternative methodologies. Previous work by Wagstaff, van Doorslaer, et al. has highlighted the sensitivity of delivery equity results to the inclusion of controls for differences in health status ? reflecting the basic issue that the health care received by lower-income persons may in part reflect their greater levels of need. There are, however, several methods to control for need ? not all of which manage equally well to preserve other population distributions (such as age, income, family composition, and education). The paper proposes a new method for needs-adjusting the data in order to control for health status in a manner that is more rigorously ceteris paribus.