Equity Vs Inequality, Basic concept and measurment

1. 1
Equity in health: Principals and measurements
Abdur Razzaque Sarker
MHE (Health Economics), MSS (Economics)
Health Economics and Financing Research, icddrb
and
PhD Fellow in Strathclyde University, UK
Email: razzaque.sarker@gmail.com

2. 2
What is equity?
Principle of being fair to all, with reference
to a defined and recognized set of values.

3. 3
Equity concepts
Market mechanism is considered fair/Nozick.
Maximising greatest happiness for greatest numbers, but
ignores distributional aspects /Utilitarianism.
Goods are distributed so that the position of the least
well off in society is maximized/ Rawls
Equal shares of a distribution of a commodity which
means equality in health and health care/ Egalitarianism

4. 4
Equity in what ?
Health
Health care delivery
Health care utilization
Health care financing

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Dimensions in Equity
Vertical equity
The principle that says that those who are in different
circumstances should be treated differently.
Horizontal equity
The principle that says that those who are in identical or
similar circumstances should be treated equally.

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Measurements
The range
The index of dissimilarity
The slope and relative indices of inequality
The Gini-coefficient
The concentration index

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Criteria to be a good measurement
of inequality in health
1. It reflects the experiences of the entire population.
2. It reflects the socioeconomic dimension of health.
3. It is sensitive to changes in the distribution of the
population across the socioeconomic groups.

8. 8
GINI-COEFFICIENT

9. 9
Gini-Coefficient
2 * (Area under diagonal – area under lorenz curve)

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Calculating Gini-Coefficient
Brown’s formula
Index =
Y = Cumulative proportion population
X = Cumulative proportion health or ill-health
k = Number of individuals
i = Individual and corresponding health in specific position

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Gini-coefficient
Pop Prop pop Cum.
Prop.
Pop (X)
Xi-Xi-1
(A)
Sickdays Prop
sickdays
Cum
prop
sickdays
(Y)
Yi+Yi-1
(B)
A*B
1 0.1 0.1 0.1 2 0.02 0.02 0.02 0.002
1 0.1 0.2 0.1 4 0.04 0.06 0.08 0.008
1 0.1 0.3 0.1 6 0.06 0.12 0.18 0.018
1 0.1 0.4 0.1 7 0.07 0.19 0.31 0.031
1 0.1 0.5 0.1 9 0.09 0.28 0.47 0.047
1 0.1 0.6 0.1 11 0.11 0.39 0.67 0.067
1 0.1 0.7 0.1 12 0.12 0.51 0.9 0.09
1 0.1 0.8 0.1 14 0.14 0.65 1.16 0.116
1 0.1 0.9 0.1 15 0.15 0.8 1.45 0.145
1 0.1 1 0.1 20 0.2 1 1.8 0.18
10 1 100 Sum = 0.704
Gini-coefficient = 1-sum(A*B)= 0.296

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CONCENTRATION INDEX

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A variant of Lorenz curve. Socioeconomic dimension
of health is included in the concentration curve.
Concentration curve plots cumulative proportion
population (ranked from the poorest to the richest
socioeconomic condition) in x-axel against poportion
injuries in y-axel.
Concentration curve

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Lorenz CurveLorenz Curve
Lorenz curve plots cumulative proportion population
(ranked from the sickest to the healthiest one) in x-axel
against poportion health in y-axel.

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Serial Pop Sick days
1 1 10
2 1 10
3 1 10
4 1 10
5 1 10
6 1 10
7 1 10
8 1 10
9 1 10
10 1 10
Sum 10 100
Equal distribution of sick days

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Lorenz curve with perfect equality
Cumulative proportion population
Cumulativep
20%
40%
60%
80%
100%
20% 40% 60% 80% 100%
O
B
C

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Inequal distribution of sickdays
Serial Pop Sickdays
1 1 2
2 1 4
3 1 6
4 1 7
5 1 9
6 1 11
7 1 12
8 1 14
9 1 15
10 1 20
Total 10 100

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Cumulative proportion population
CumulativeproportionQALYs
Lorenz curve with inequality in QALYs
20%
40%
60%
80%
100%
20% 40% 60% 80% 100%
•
•
•
•
O
B´
B
C

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Cumulative proportion population
(ranked from poorest to richest)
Cumulativeproportionsickdays
Concentration curve of sickdays
20%
40%
60%
80%
100%
20% 40% 60% 80% 100%
•
•
•
•
O
B´
B
C

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Concentration Index
2*(area under diagonal – area under concentration curve)

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Calculating concentration index
Pop Prop pop Cum.
Prop. Pop
(X)
Xi-Xi-1 (A) Sickdays Prop
sickdays
Cum
prop
sickdays
(Y)
Yi+Yi-1
(B)
A*B
1 (Poorest) 0.1 0.1 0.1 14 0.184 0.184 0.184 0.018
1 0.1 0.2 0.1 12 0.158 0.342 0.526 0.053
1 0.1 0.3 0.1 10 0.132 0.474 0.816 0.082
1 0.1 0.4 0.1 9 0.118 0.592 1.066 0.107
1 0.1 0.5 0.1 8 0.105 0.697 1.289 0.129
1 0.1 0.6 0.1 7 0.092 0.789 1.487 0.149
1 0.1 0.7 0.1 6 0.079 0.868 1.658 0.166
1 0.1 0.8 0.1 5 0.066 0.934 1.803 0.18
1 0.1 0.9 0.1 3 0.039 0.974 1.908 0.191
1 (Richest) 0.1 1 0.1 2 0.026 1 1.974 0.197
1 76 1.271
Concentration Index = 1-sum(A*B)= -0.271

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1. It reflects the experiences of the entire
population.
2. It reflects the socioeconomic dimension of
health.
3. It is sensitive to changes in the distribution of
the population across the socioeconomic groups.
Check if Gini-coefficient and concentration index satisfy
the following criteria.

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Email: razzaque.sarker@gmail.com
THANK YOU