Horizontal equity in health care utilization evidence from three high-income Asian economies.
Identifieur interne : 000097 ( Ncbi/Curation ); précédent : 000096; suivant : 000098Horizontal equity in health care utilization evidence from three high-income Asian economies.
Auteurs : Jui-Fen R. Lu [Taïwan] ; Gabriel M. Leung ; Soonman Kwon ; Keith Y K. Tin ; Eddy Van Doorslaer ; Owen O'DonnellSource :
- Social science & medicine (1982) [ 0277-9536 ] ; 2007.
Descripteurs français
- KwdFr :
- MESH :
English descriptors
- KwdEn :
- MESH :
- geographic : Asia.
- economics : Delivery of Health Care, National Health Programs.
- statistics & numerical data : Delivery of Health Care, Patient Acceptance of Health Care.
- Health Surveys, Humans, Socioeconomic Factors.
Abstract
This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions.
DOI: 10.1016/j.socscimed.2006.08.033
PubMed: 17014944
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Horizontal equity in health care utilization evidence from three high-income Asian economies.</title><author><name sortKey="Lu, Jui Fen R" sort="Lu, Jui Fen R" uniqKey="Lu J" first="Jui-Fen R" last="Lu">Jui-Fen R. Lu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Health Care Management, Chang Gung University, Taiwan. rachel@mail.cgu.edu.tw</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Health Care Management, Chang Gung University</wicri:regionArea><wicri:noRegion>Chang Gung University</wicri:noRegion></affiliation></author><author><name sortKey="Leung, Gabriel M" sort="Leung, Gabriel M" uniqKey="Leung G" first="Gabriel M" last="Leung">Gabriel M. Leung</name></author><author><name sortKey="Kwon, Soonman" sort="Kwon, Soonman" uniqKey="Kwon S" first="Soonman" last="Kwon">Soonman Kwon</name></author><author><name sortKey="Tin, Keith Y K" sort="Tin, Keith Y K" uniqKey="Tin K" first="Keith Y K" last="Tin">Keith Y K. Tin</name></author><author><name sortKey="Van Doorslaer, Eddy" sort="Van Doorslaer, Eddy" uniqKey="Van Doorslaer E" first="Eddy" last="Van Doorslaer">Eddy Van Doorslaer</name></author><author><name sortKey="O Donnell, Owen" sort="O Donnell, Owen" uniqKey="O Donnell O" first="Owen" last="O'Donnell">Owen O'Donnell</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2007">2007</date><idno type="doi">10.1016/j.socscimed.2006.08.033</idno><idno type="RBID">pubmed:17014944</idno><idno type="pmid">17014944</idno><idno type="wicri:Area/PubMed/Corpus">000158</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000158</idno><idno type="wicri:Area/PubMed/Curation">000158</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000158</idno><idno type="wicri:Area/PubMed/Checkpoint">000158</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000158</idno><idno type="wicri:Area/Ncbi/Merge">000097</idno><idno type="wicri:Area/Ncbi/Curation">000097</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Horizontal equity in health care utilization evidence from three high-income Asian economies.</title><author><name sortKey="Lu, Jui Fen R" sort="Lu, Jui Fen R" uniqKey="Lu J" first="Jui-Fen R" last="Lu">Jui-Fen R. Lu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Health Care Management, Chang Gung University, Taiwan. rachel@mail.cgu.edu.tw</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Health Care Management, Chang Gung University</wicri:regionArea><wicri:noRegion>Chang Gung University</wicri:noRegion></affiliation></author><author><name sortKey="Leung, Gabriel M" sort="Leung, Gabriel M" uniqKey="Leung G" first="Gabriel M" last="Leung">Gabriel M. Leung</name></author><author><name sortKey="Kwon, Soonman" sort="Kwon, Soonman" uniqKey="Kwon S" first="Soonman" last="Kwon">Soonman Kwon</name></author><author><name sortKey="Tin, Keith Y K" sort="Tin, Keith Y K" uniqKey="Tin K" first="Keith Y K" last="Tin">Keith Y K. Tin</name></author><author><name sortKey="Van Doorslaer, Eddy" sort="Van Doorslaer, Eddy" uniqKey="Van Doorslaer E" first="Eddy" last="Van Doorslaer">Eddy Van Doorslaer</name></author><author><name sortKey="O Donnell, Owen" sort="O Donnell, Owen" uniqKey="O Donnell O" first="Owen" last="O'Donnell">Owen O'Donnell</name></author></analytic><series><title level="j">Social science & medicine (1982)</title><idno type="ISSN">0277-9536</idno><imprint><date when="2007" type="published">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Asia</term><term>Delivery of Health Care (economics)</term><term>Delivery of Health Care (statistics & numerical data)</term><term>Health Surveys</term><term>Humans</term><term>National Health Programs (economics)</term><term>Patient Acceptance of Health Care (statistics & numerical data)</term><term>Socioeconomic Factors</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acceptation des soins par le patient ()</term><term>Asie</term><term>Enquêtes de santé</term><term>Facteurs socioéconomiques</term><term>Humains</term><term>Prestations des soins de santé ()</term><term>Prestations des soins de santé (économie)</term><term>Programmes nationaux de santé (économie)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Asia</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Delivery of Health Care</term><term>National Health Programs</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Delivery of Health Care</term><term>Patient Acceptance of Health Care</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Prestations des soins de santé</term><term>Programmes nationaux de santé</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Health Surveys</term><term>Humans</term><term>Socioeconomic Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Acceptation des soins par le patient</term><term>Asie</term><term>Enquêtes de santé</term><term>Facteurs socioéconomiques</term><term>Humains</term><term>Prestations des soins de santé</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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