http://repub.eur.nl/res/concept/jel-D63/ Recent publications classified by JEL Code D63 en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/32892/ 2012-06-26T00:00:00Z We propose a method of measuring and decomposing inequity in health care utilisation that allows for heterogeneity in the use-need relationship. This makes explicit inequity that derives from unequal treatment response to variation in need, as well as that due to differential effects of non-need determinants. Under plausible conditions concerning heterogeneity in the use-need relationship and the distribution of need, existing methods that impose homogeneity will underestimate pro-rich inequity. This prediction is confirmed for four middle-income Asian countries. In those countries, around one half of the observed socioeconomic inequality is due to utilisation being more responsive to need among the higher wealth and urban dwelling individuals. Van de Poel, E. Doorslaer, E.K.A. van O'Donnell, O.A. http://repub.eur.nl/res/pub/37312/ 2012-06-13T00:00:00Z During the last decades, China has experienced double-digit economic growth rates and rising inequality. This paper implements a new decomposition on the China Health and Nutrition panel Survey (1991-2006) to examine the extent to which changes in level and distribution of incomes and in income mobility are related to health disparities between rich and poor. We find that health disparities in China relate to rising income inequality and in particular to the adverse health and income experience of older (wo)men, but not to the growth rate of average incomes over the last decades. These findings suggest that replacement incomes and pensions at older ages may be one of the most important policy levers in combating health disparities between rich and poor Chinese. Baeten, S.A. Ourti, T.G.M. van Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/37311/ 2012-05-21T00:00:00Z We apply the theory of inequality in opportunity to measure inequity in mortality. Our empirical work is based on a rich dataset for the Netherlands (1998-2007), linking information about mortality, health events and lifestyles. We show that distinguishing between different channels via which mortality is affected is necessary to test the sensitivity of the results with respect to different normative positions. Moreover, our model allows for a comparison of the inequity in simulated counterfactual situations, including an evaluation of policy measures. We explicitly make a distinction between inequity in mortality risks and inequity in mortality outcomes. The treatment of this difference - “luck”- has a crucial in‡uence on the results. García-Gómez, P. Ourti, T.G.M. van Bago d'Uva, T. http://repub.eur.nl/res/pub/32664/ 2012-04-26T00:00:00Z As societies are increasingly concerned with social risks, it is important to evaluate risks not only from an individual perspective, but also from a societal one. Many increases in social risk involve a simultaneous increase in risk and inequality. This paper presents an experiment which disentangles concerns for risk and inequality in a social risk context. Subjects choose between different types of allocations of risks over 10 other participants. The allocations differ only in terms of dispersion. We disentangle four types of dispersion: ex ante inequality, ex post inequality, individual risk, and collective risk. The results show that people are averse towards ex ante inequality and individual risk, whereas they are ex post inequality and collective risk seeking. Rohde, I.M.T. Rohde, K.I.M. http://repub.eur.nl/res/pub/32659/ 2012-04-01T00:00:00Z The introduction of the New Cooperative Medical Scheme in rural China is one of the largest health care reforms in the developing world since the millennium. The literature to date has mainly used the uneven rollout of NCMS across counties as a way of identifying its effects on access to care and financial protection. This study exploits the cross-county variation in NCMS generosity in 2006 and 2008 in Ningxia and Shandong province and adopts an instrumenting approach to estimate the effect of a continuous measure of coverage level. Our results confirm earlier findings of NCMS being effective in increasing access to care, but not increasing financial protection. In addition, we find that NCMS enrollees are sensitive to the incentives set in the NCMS design when choosing their provider, but also that providers seem to respond by increasing prices and/or providing more expensive care. Hou, Z. Van de Poel, E. Doorslaer, E.K.A. van Menge, Q. http://repub.eur.nl/res/pub/38491/ 2012-01-01T00:00:00Z The paper argues that the notion of Pareto efficiency builds on two normative assumptions: the more general consequentialist norm of any efficiency criterion, and the strong no-harm principle of the prohibition of any redistribution during the economic process that hurts at least one person. These normative concerns lead to a constrained and static notion of efficiency in mainstream economics, ignoring dynamic efficiency gains from more equal allocations of resources. The paper argues that a weak no-harm principle instead provides an endogenous efficiency criterion, which shifts attention away from equilibrium analysis in hypothetically perfect markets towards an evolutionary analysis of efficiency in real-world, non-equilibrium markets. Moreover, such an evolutionary notion of efficiency would be less normative than the Paretian concept. Staveren, I.P. van http://repub.eur.nl/res/pub/37327/ 2012-01-01T00:00:00Z The concentration index is widely used to measure income-related inequality in health. No insight exists, however, whether the concentration index connects with people's preferences about distributions of income and health and whether a reduction in the concentration index reflects an increase in social welfare. We explored this question by testing the central assumption underlying the concentration index and found that it was systematically violated. We also tested the validity of alternative health inequality measures that have been proposed in the literature. Our data showed that decreases in the spread of income and health were considered socially desirable, but decreases in the correlation between income and health not necessarily. Support for a condition implying that the inequality in the distribution of income and in the distribution of health can be considered separately was mixed. Bleichrodt, H. Rohde, K.I.M. Ourti, T.G.M. van http://repub.eur.nl/res/pub/26864/ 2011-10-01T00:00:00Z We propose a method of measuring and decomposing inequity in health care utilisation that allows for heterogeneity in the use-need relationship. This makes explicit inequity that derives from unequal treatment response to variation in need, as well as that due to differential effects of non-need determinants. Under plausible conditions concerning heterogeneity in the use-need relationship and the distribution of need, existing methods that impose homogeneity will underestimate pro-rich inequity. This prediction is confirmed for four low-middle income Asian countries. Van de Poel, E. Doorslaer, E.K.A. van O'Donnell, O.A. http://repub.eur.nl/res/pub/26869/ 2011-07-01T00:00:00Z The tools to be used and other choices to be made when measuring socioeconomic inequalities with rank-dependent inequality indices have recently been debated in this journal. This paper adds to this debate by stressing the importance of the measurement scale, by providing formal proofs of several issues in the debate, and by lifting the curtain on the confusing debate between adherents of absolute versus relative health differences. We end this paper with a 'matrix' that provides guidelines on the usefulness of several rank-dependent inequality indices under varying circumstances. Erreygers, G. Ourti, T.G.M. van http://repub.eur.nl/res/pub/20283/ 2010-08-02T00:00:00Z The tools to be used and other choices to be made when measuring socioeconomic inequalities with rank-dependent inequality indices have recently been debated in this journal. This paper adds to this debate by stressing the importance of the measurement scale, by providing formal proofs of several issues in the debate, and by lifting the curtain on the confusing debate between adherents of absolute versus relative health differences. We end this paper with a "matrix" that provides guidelines on the usefulness of several rank-dependent inequality indices under varying circumstances Erreygers, G. Ourti, T.G.M. van http://repub.eur.nl/res/pub/21462/ 2010-08-01T00:00:00Z Abstract: When process fairness deviates from outcome fairness, dynamic inconsistencies can arise as in nonexpected utility. Resolute choice (Machina) can restore dynamic consistency under nonexpected utility without using Strotz's precommitment. It can similarly justify dynamically consistent process fairness. Trautmann, S.T. Wakker, P.P. http://repub.eur.nl/res/pub/22137/ 2010-06-01T00:00:00Z Happiness is not the same as capability, but the matters are related. Capability is obviously required for living a happy life and happiness feeds back on capability in several ways. Capabilities affect happiness not only at the individual level, but also indirectly at the societal level. For instance: school education does not seem to make pupils any happier, but a high level of education is required for modern society that does add to happiness. Insight in the interrelations between capability and happiness is required for making policy choices. If the prime aim is greater happiness for a greater number, one must know what capabilities are most functional for happiness in the given conditions. If the cultivation of capabilities is prioritized, one must at least acknowledge the possible loss of happiness. Inspection of the available data does not reveal much conflict Veenhoven, R. http://repub.eur.nl/res/pub/22135/ 2010-01-01T00:00:00Z Abstract Happiness is not the same as capability, but the matters are related. Capability is obviously required for living a happy life and happiness feeds back on capability in several ways. Capabilities affect happiness not only at the individual level, but also indirectly at the societal level. For instance: school education does not seem to make pupils any happier, but a high level of education is required for modern society that does add to happiness. Insight in the interrelations between capability and happiness is required for making policy choices. If the prime aim is greater happiness for a greater number, one must know what capabilities are most functional for happiness in the given conditions. If the cultivation of capabilities is prioritized, one must at least acknowledge the possible loss of happiness. Inspection of the available data does not reveal much conflict Veenhoven, R. http://repub.eur.nl/res/pub/22539/ 2010-01-01T00:00:00Z SUMMARY Women's bargaining power is generally analyzed only with individual level and household level variables. We add a third level, namely institutional bargaining power. We define this as bargaining power which one party freely derives from unequal social norms. In the bargaining literature there is a common paradoxical finding, namely that more access to and control over individual resources sometimes decreases rather than increases women‟s bargaining outcomes. With household survey data from Ethiopia and making use of multi-level modeling and an aggregate model with interaction terms, we suggest that this paradoxical effect can be explained by very unequal gender norms – gendered institutions – at the group level. In our case, we used ethnic groups to show that in groups where gender norms are very unequal, individual and household level bargaining power variables effects are mediated by ethnic gendered institutions. A policy implication of our findings is that gender policy may become more effective with shifting the emphasis from a largely individual approach to an institutional approach to support women's empowerment. Staveren, I.P. van Mabsout, R. http://repub.eur.nl/res/pub/17476/ 2008-03-01T00:00:00Z We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care. O'Donnell, O.A. Doorslaer, E.K.A. van Racelis, R. Tin, K. Rannan-Eliya, R.P. Tisayaticom, K. Trisnantoro, L. Wan, Q. Yang, B-M. Zhao, Y. Somanathan, A. Adhikari, S.R. Huq, M.N. Akkazieva, B. Harbianto, D. Garg, C.C. Hanvoravongchai, P. Herrin, A.N. Ibragimova, S. Karan, A. Kwon, S-M. Leung, G.M. Lu, J-F.R. Ohkusa, Y. Pande, B.R. http://repub.eur.nl/res/pub/34775/ 2007-01-01T00:00:00Z Previous poverty assessments of Burkina Faso neglected some important methodological issues. They were therefore misleading and led to the so-called 'Burkinabè Growth-Poverty Parado', i.e., increasing poverty despite sustained macro-economic growth and constant inequality. We estimate that poverty significantly decreased between 1994 and 2003, i.e., growth was in contrast to what previous poverty estimates suggested 'pro-poor'. However, we also demonstrate that between 1994 and 1998, poverty indeed increased despite a good macro-economic performance. This was caused by a severe drought and the devaluation of the CFA Franc, which led to a profound deterioration of the purchasing power of the poor, an issue, which was also overseen by previous studies. Grimm, M. Günther, I. http://repub.eur.nl/res/pub/10954/ 2006-09-01T00:00:00Z The empirical literature on the measurement of health inequalities is vast and rapidly expanding. To date, however, no foundation in welfare economics exists for the proposed measures of health inequality. This paper provides such a foundation for commonly used measures like the health concentration index, the Gini index, and the extended concentration index. Our results indicate that these measures require assumptions that appear restrictive. One way forward may be the development of multi-dimensional extensions. Bleichrodt, H. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/7301/ 2006-01-26T00:00:00Z In the year 2000 some $142 billion in royalties were paid internationally by users of a specific piece of knowledge that were protected under Intellectual Property Right law (IPR) to those parties that owned these rights. Under current circumstances where knowledge & innovation play an increasingly significant role in the economy (Foray & Lundvall 1996, Cowan, David and Foray 2000, Cooke 2002, Dolfsma & Soete 2006, Dolfsma 2005). IPRs have become increasingly prominent in debates and are almost unanimously deemed to favor economic development by policymakers, and certainly by policymakers in developed countries. While it has been acknowledged that some parties may benefit more from a system of IPRs than others, in relative terms a Pareto improvement is the expected outcome (Langford 1997). This has not always been the case. In addition, the academic (economic) community is almost unanimous about the system of IPR overshooting its goals. This has been the motivation to include IPRs in the WTO negotiations. The TRIPS agreement (Trade-Related Aspects of Intellectual Property Rights) has resulted in 1994 from these negotiations. Especially during the 1990s the number of patents granted has grown tremendously despite the fact that many a scholar still supports Machlup’s (1958, p.28) conclusion that: “it would be irresponsible, on the basis of our present knowledge of its consequences, to recommend instituting one. But since we have had a patent system for a long time, it would be irresponsible, on the basis of our present knowledge, to recommend abolishing it.” From other corners, where specific effects of IPRs are considered, a different and less circumspect sound may be heard. Examples of this are attempts to make available HIV/AIDS drugs at a reduced price compared to what the pharmaceutical companies that have the patents on these drugs demand. I will focus on patents. Empirical and theoretical findings bearing on the question of IPRs’ effect on technological development, and thus prospect for economic development, are reviewed. Static and dynamic effects are distinguished. Areas where static effects may be expected include transfer of knowledge, balance of payment effects, effects for large as opposed to small firms, and effect on the ‘extent of the market’. Areas for dynamic effects include technological development and technological preemption. The list may not be exhaustive, and effects are interlocking: they may be mutually reinforcing or they may conflict. I will mostly focus on ‘dynamic’ effects. Dolfsma, W.A. http://repub.eur.nl/res/pub/10990/ 2005-07-01T00:00:00Z We performed an empirical elicitation of the equity-efficiency trade-off in cost-utility analysis using the rank-dependent quality-adjusted life-year (QALY) model, a model that includes as special cases many of the social welfare functions that have been proposed in the literature. Our elicitation method corrects for utility curvature and, therefore, our estimated equity weights are not affected by diminishing marginal utility. We observed a preference for equality in the allocation of health. The data suggest that the elicited equity weights were jointly determined by preferences for equality and by insensitivity to group size. A procedure is proposed to correct the equity weights for insensitivity to group size. Finally, we give an illustration how our method can be implemented in health policy. Bleichrodt, H. Doctor, J.N. Stolk, E.A. http://repub.eur.nl/res/pub/6617/ 2004-08-01T00:00:00Z We examine linkages between aggregate household income, distribution of that income, and aggregate cross-country expenditure patterns. We are able to decompose income effects into international income dispersion effects (from variations in average income) and national income dispersion (income distribution) effects. This yields insights for relevant aggregate household specifications in computational policy models emphasizing household distribution of income. This also yields a consumption-pattern based inequality index that summarizes the projection of inequality through expenditure patterns. Estimation of flexible demand systems with representative expenditures (which reflects income distribution within countries) yields a significant relationship between representative consumption and cross-country demand patterns. Fillat, C. François, J.F.