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www.worldbank.org/analyzinghealthequity. Book published by the World Bank in 2008. Presentations accompany the book and are designed as a course on health equity analysis. The book contents can be downloaded from the website above. .

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slide1
www.worldbank.org/analyzinghealthequity

Book published by the

World Bank in 2008.

Presentations accompany

the book and are

designed as a course on

health equity analysis.

The book contents can be

downloaded from the

website above.

analyzing health equity using household survey data

Analyzing Health Equity Using Household Survey Data

Lecture 1

Introduction

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

huge rich poor inequalities in health outcomes and health care in bolivia
Huge rich-poor inequalities in health outcomes and health care in Bolivia

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

and bolivia is not an isolated example in latin america and the caribbean
And Bolivia is not an isolated example in Latin America and the Caribbean….

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

health inequality and inequity
Health inequality and inequity
  • Rich-poor inequalities in health largely, if not entirely, derive from differences in constraints (e.g. incomes, time costs, health insurance, environment) rather than in preferences.
  • Hence they are often considered to represent inequities.
  • But in high-income countries the poor often use more health care and this may not be represent inequity.
  • Drawing conclusions about health equity involves consideration of the causes of health inequalities.

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

equity of what
Equity of what?
  • Health outcomes, e.g. infant mortality, child growth, disability, incidence of illness, general health, life expectancy.
  • Health care utilisation, e.g. doctor visits, inpatient stays, vaccinations, maternity care.
  • Subsidies received through use of public health care.
  • Payments for health care (both direct and indirect).

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

equity in relation to what
Equity in relation to what?
  • Equity in health, health care and health payments could be examined in relation to gender, ethnicity, geographic location, education, income….
  • This course focuses on equity by socioeconomic status, usually measured by income, wealth or consumption.
  • Many of the techniques are applicable to equity in relation to other characteristics but they often require that individuals can be ranked by that characteristic.

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

course objectives
Course objectives
  • To provide a step-by-step practical guide to the measurement of various aspects of health equity.
  • To introduce the relevant theory and literature.
  • To provide hands-on experience of computing health equity measures using Stata®.
  • To illustrate the interpretation of results through worked examples.
  • To stimulate analysis that will facilitate more comprehensive monitoring of health equity, especially in developing countries.

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

questions addressed by health equity analyses
Questions addressed by health equity analyses
  • Snapshots. Does inequality in child survival between the poor and better-off exist? How large is it?
  • Movies. Is inequality in child survival smaller now than in the 1990s?
  • Cross-country comparisons. Is inequality in child survival larger in Brazil than in Cuba?
  • Decompositions. To what extent is inequality in child survival explained by inequalities in education, health insurance cover, access to maternal and child health care, etc?
  • Cross-country detective exercises. To what extent is greater inequality in child survival in Brazil than Cuba explained by greater income inequality, given differences in health systems?
  • Program impact evaluations. To what extent is inequality in child survival reduced by an intervention such as a vaccination program, expanded health insurance cover or improved water supply?

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

ingredients of health equity analysis
Ingredients of health equity analysis
  • Data usually from a household survey.
  • Measurement of the key variables - health/health care/health payments and of socioeconomic status.
  • Quantitative measures of inequality or inequity.
  • Multivariate methods to explain inequality, identify its causes and the impact on it of interventions

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

course content
Course content
  • The course is structured around these four ingredients, plus applications.
  • Part I – Data
    • data requirements and sources (lecture 2)
    • measurement of the key variables – child survival, anthropometrics, adult health & living standards (3-6).
  • Part II – Tools
    • measures of socioeconomic inequality in health variables (7-9)
    • multivariate analysis (10-11)
    • decomposition methods (12-13).
  • Part III – Applications
    • to health care utilisation (14-15)
    • to health payments (16-19).

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

concentration curves lecture 7 are central to the assessment of socioeconomic inequality in health
Concentration curves (lecture 7) are central to the assessment of socioeconomic inequality in health

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

concentration index lecture 8 is a tie breaker but rests on certain value judgments
Concentration index (lecture 8) is a tie-breaker, but rests on certain value judgments

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

multivariate methods
Multivariate methods
  • Estimation and inference with complex survey data (lecture 10)
  • Nonlinear models for health and medical expenditure data (11)
  • Explaining differences between groups: Oaxaca decomposition (12)
  • Explaining socioeconomic-related health inequality: Decomposition of the concentration index (13)

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

lecture 14 who really benefits from health care subsidies often the better off
Lecture 14: Who (really) benefits from health care subsidies? Often the better off!

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

lecture 16 who really pays for health care
Lecture 16: Who (really) pays for health care?

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

lecture 18 incidence of catastrophic out of pocket payments varies across countries
Lecture 18: Incidence of catastrophic out-of-pocket payments varies across countries

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

lecture 19 health care payments and poverty
Lecture 19: Health care payments and poverty

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

acknowledgements
Acknowledgements
  • Participants in the ECuity and Equitap projects
  • The European Commission INCO-DEV programme (ICA4-CT-2001-10015) that funded the Equitap project.
  • The Dutch government for financial support for the production and printing of the book and these slides through Reaching the Poor II
  • Davidson Gwatkin and Abdo Yazbeck for encouragement and support during the production and market-testing of the technical notes, and the production of the volume
  • John Didier, Tanya Ringland, Chialing Yang and others at the World Bank Institute for managing the production and dissemination of the book

“Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

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