Quantifying Income-Related Inequality in Healthcare Delivery in the United States

Bibliographic Data

ID9102051
AuthorsAlex Y Chen (Children's Hospital of Los Angeles, corresponding author), José J Escarce
Year2004
Volume42
Issue1
Pages38-47
Publication date2004-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.mlr.0000103526.13935.b5
PMID14713738
OpenAlexW2017074488
LanguageEN
Citations received7
References cited24

BACKGROUND: Numerous studies have found that high-income Americans use more medical care than their low-income counterparts, irrespective of medical "need." The methods employed in these studies, however, make it difficult to evaluate differences in the degree of income-related inequality in utilization across population subgroups. In this study, we derive a summary index to quantify income-related inequality in need-adjusted medical care expenditures and report values of the index for adults and children in the United States. METHODS: We used the summary index of income-related inequality in expenditures developed by Wagstaff et al. 1 The source of data for the study was the Household Component of the 1996-1998 Medical Expenditure Panel Survey, which contains person-level data on medical care expenditures, demographic characteristics, household income, and a wide array of health status measures. We used multivariate regression analysis to predict need-adjusted annual medical care expenditures per person by income level and used the predictions to calculate the indices of inequality. Separate indices were calculated for all adults, working-age adults, seniors, and children ages 5 to 17. RESULTS: For all age groups, predicted expenditures per person, adjusted for medical need, generally increased as income rose. The index of inequality for all adults was +0.087 (95% confidence interval, +0.035, +0.139); for working-age adults, +0.099 (+0.046, +0.152); for seniors, +0.147 (+0.059, +0.235); and for children, +0.067 (+0.006, +0.128). CONCLUSIONS: There exists income-related inequality in medical care expenditures in the United States, and it favors the wealthy. The inequality is highest among seniors despite Medicare, intermediate among working-age adults, and lowest among children

Demographic economics · Economic growth · Economic inequality · Economics · Health care · Health care delivery · Health equity · Healthcare delivery · Income distribution · Inequality · Health disparities and outcomes · Healthcare Policy and Management · Healthcare Systems and Reforms · Mathematics

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