© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research Chapter 19

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Evaluation of Health disparities from the economic perspective differentiates the economic factors from other social factors  Life span, quality of life rose with growth of medical technologies, incomes and medical insurance.  Uninsured population in 2003 estimated at 61 million persons (19 to 64 years old)  Economics is the most important primal indicator in health care disparities

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Economic Dimension of Health Disparities  Economic definition: social science, consists in health, public finances, industrial, organization, housing, regional and urban, risk and uncertainty, econometrics, energy, agricultural and resource, health education and welfare and urban planning.  Two fields Macroeconomics : broad activities, performance and trends Microeconomics : economic behavior of small groups, efficiency of the resources

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Economic Status and Its Measurement  Assessment of economic status Earnings, consumption, expenditures, permanent income, wealth and proxies  Consumption expenditure  Current income  Wealth  Permanent income Extensive research in disparities economics has shown relationship between economic status measured and health incomes.

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Economic factors in correlation with noneconomic factors are important determinants of health disparities.  Income deprivation and social cohesion factors are critical factors of mental health disparities.

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research Income Distribution  Differences or variations of health status or outcomes exist across differing economic groups.  Indicators or indexes can be used to capture health disparities.  Health outcomes are compared among the quintiles, quartiles or deciles.  This classification does not reflect changes over time

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Lorenz Curve and Gini Coefficient  Lorenz curve is a graphical presentation showing the degree of inequality of a frequency distribution in which the accumulative percentage of health indicators is plotted on the Y-axis against the cumulative percentage of the population ordered/ranked by income on the horizontal X-axis.

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Concentration Curve and Concentration Index  This curve ranks population by their economic status, not health, it plots the cumulative percentage of the population ranked by economic status from the most disadvantaged to the least disadvantaged against the concentrated among the lower economic classes.

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research Some Evidence on Economic Studies of Health Disparities  Concentration index has been used to measure the changes in socioeconomic inequality and prevalence of being overweight in U.S adolescents  Other studies used concentration indexes in Finland, Norway, Sweden, suggest that lower socioeconomic status associated with reporting more illnesses  Infant mortality in Iran  Bangladesh study  India Study  Canadian study

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Some Policy Reflections  Health inequalities remain a central concern of health policy  The efforts cut across local communities and around the world  Policy instruments  Health policies  Programs  Community based initiatives

© 2010 Jones and Bartlett Publishers, LLC The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research  Some Policy Reflections  U.S Health Care system is an employment-based insurance coverage design, fragmented and expensive, leading in wider health inequities between the well-off and the poor who are unemployed or work without insurance coverage.  Australia public-private system has an equal access to physicians, hospitals and dental care.