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Analyzing Health Equity Using Household Survey Data——A Guide toTechniques and Their Implementation
[size=13.3333px]Author：
[size=13.3333px]Owen O’Donnell
[size=13.3333px]Eddy van Doorslaer
[size=13.3333px]Adam Wagstaff
[size=13.3333px]Magnus Lindelow
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[size=13.3333px]
Health outcomesare invariably worse among the poor—often markedly so. The chance of a newbornbaby in Bolivia dying before his or her fifth birthday is more than three timeshigher if the parents are in the poorest fifth of the population than if theyare in the richest fifth (120‰ compared with 37‰). Reducing inequalities suchas these is widely perceived as intrinsically important as a development goal.But as the World Bank’s 2006 World Development Report, Equity and Development,argued, inequalities in health reflect and reinforce inequalities in other domains,and these inequalities together act as a brake on economic growth and development.
One challenge isto move from general statements such as that above to monitoring progress overtime and evaluating development programs with regard to their effects onspecific inequalities. Another is to identify countries or provinces in countriesin which these inequalities are relatively small and discover the secrets of theirsuccess in relation to the policies and institutions that make for smallinequalities.
This book sets outto help analysts in these tasks. It shows how to implement a variety ofanalytic tools that allow health equity—along different dimensions and indifferent spheres—to be quantified. Questions that the techniques can help provideanswers for include the following: Have gaps in health outcomes between the poorand the better-off grown in specific countries or in the developing world as a whole?Are they larger in one country than in another? Are health sector subsidies moreequally distributed in some countries than in others? Is health careutilization equitably distributed in the sense that people in equal needreceive similar amounts of health care irrespective of their income? Are healthcare payments more progressive in one health care financing system than inanother? What are catastrophic payments? How can they be measured? How far dohealth care payments impoverish households?
Typically, eachchapter is oriented toward one specific method previously outlined in a journalarticle, usually by one or more of the book’s authors. For example, one chaptershows how to decompose inequalities in a health variable (be it a health outcomeor utilization) into contributions from different sources—the contribution fromeducation inequalities, the contribution from insurance coverage inequalities, andso on. The chapter shows the reader how to apply the method through worked examplescomplete with Stata code.
Most chapters wereoriginally written as technical notes downloadable from the World Bank’sPoverty and Health Web site (www.worldbank.org/povertyandhealth). They haveproved popular with government officials, academic researchers, graduatestudents, nongovernmental organizations, and international organization staff,including operations staff in the World Bank. They have also been used
in training exercisesrun by the World Bank and universities. These technical notes were allextensively revised for the book in light of this “market testing.” By collectingthese revised notes in the form of a book, we hope to increase their use and usefulnessand thereby to encourage further empirical work on health equity that ultimatelywill help shape policies to reduce the stark gaps in health outcomes seen inthe developing world today.
François J.Bourguignon
Senior VicePresident
and ChiefEconomist
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