Income-rich and wealth-poor? The impact of measures of socio-economic status in the analysis of the distribution of long-term care use among older people
Corresponding Author
Ricardo Rodrigues
European Centre for Social Welfare Policy and Research, Vienna, Austria
Correspondence
Ricardo Rodrigues, European Centre for Social Welfare Policy and Research, Berggasse 17, 1090 Vienna, Austria.
Email: [email protected]
Search for more papers by this authorStefania Ilinca
European Centre for Social Welfare Policy and Research, Vienna, Austria
Search for more papers by this authorAndrea E. Schmidt
Austrian Public Health Institute, Stubenring, Vienna, Austria
Search for more papers by this authorCorresponding Author
Ricardo Rodrigues
European Centre for Social Welfare Policy and Research, Vienna, Austria
Correspondence
Ricardo Rodrigues, European Centre for Social Welfare Policy and Research, Berggasse 17, 1090 Vienna, Austria.
Email: [email protected]
Search for more papers by this authorStefania Ilinca
European Centre for Social Welfare Policy and Research, Vienna, Austria
Search for more papers by this authorAndrea E. Schmidt
Austrian Public Health Institute, Stubenring, Vienna, Austria
Search for more papers by this authorAbstract
This article aims to investigate the impact of using 2 measures of socio-economic status on the analysis of how informal care and home care use are distributed among older people living in the community. Using data from the Survey of Health, Ageing and Retirement in Europe for 14 European countries, we estimate differences in corrected concentration indices for use of informal care and home care, using equivalised household net income and equivalised net worth (as a proxy for wealth). We also calculate horizontal inequity indices using both measures of socio-economic status and accounting for differences in need. The findings show that using wealth as a ranking variable results, as a rule, in a less pro-poor inequality of use for both informal and home care. Once differences in need are controlled for (horizontal inequity), wealth still results in a less pro-poor distribution for informal care, in comparison with income, whereas the opposite is observed for home care. Possible explanations for these differences and research and policy implications are discussed.
Supporting Information
| Filename | Description |
|---|---|
| hec3607-sup-0001-Figure_S1.docxWord 2007 document , 507.9 KB |
Figure S1. Concentration curves for use of informal care by income and wealth (dominance test results in parentheses) Table S1. Consistency of ranking with different SES measures (percentages) |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- Adena, M., & Myck, M. (2014). Poverty and transitions in health in later life. Social Science & Medicine, 116, 202–210.
- Allin, S., Masseria, C., & Mossialos, E. (2009). Measuring socioeconomic differences in use of health care services by wealth versus by income. American Journal of Public Health, 99(10), 1849–1855.
- Allin, S., Masseria, C., & Mossialos, E. (2011). Equity in health care use among older people in the UK: An analysis of panel data. Applied Economics, 43(18), 2229–2239.
- Arber, S., & Ginn, J. (1991). The invisibility of age: Gender and class in later life. The Sociological Review, 39(2), 260–291.
- Avlund, K., Damsgaard, M. T., & Osler, M. (2004). Social position and functional decline among non-disabled old men and women. European Journal of Public Health, 14(2), 212–216.
- Bakx, P., de Meijer, C., Schut, F. T. & vanDoorslaer, E. (2015). Going formal or informal, who cares? The influence of public long-term care insurance. Health Economics, 24, 631–643.
- Börsch-Supan, A. & Jürges, H. (2005). The survey of health, aging, and retirement in Europe: Methodology, (September).
- Breeze, E., Sloggett, A., & Fletcher, A. (1999). Socioeconomic and demographic predictors of mortality and institutional residence among middle aged and older people: Results from the longitudinal study. Journal of Epidemiology and Community Health, 53, 765–774.
- Christelis, D. (2011). Imputation of missing data in Waves 1 and 2 of SHARE, Available at: http://www.share-project.org/uploads/tx_sharepublications/WP_Series_01-2011_Christelis.pdf.
- Christensen, U., et al. (2014). Addressing social inequality in aging by the Danish occupational social class measurement. Journal of Aging and Health, 26(1), 106–127.
- Colombo, F., et al. (2011). Help wanted? Providing and paying for long-term care. Paris: Organisation for Economic Co-operation and Development Publishing.
10.1787/9789264097759-en Google Scholar
- Costa-Font, J. (2008). Housing assets and the socio-economic determinants of health and disability in old age. Health & Place, 14, 478–491.
- Cubbin, C., et al. (2011). Assessing alternative measures of wealth in health research. American Journal of Public Health, 101(5), 939–947.
- de Jong Gierveld, J., Dykstra, P. A., & Schenk, N. (2012). Living arrangements, intergenerational support types and older adult loneliness in Eastern and Western Europe. Demographic Research, 27, 167–200.
- De Luca, G., Celidoni, M., & Trevisan, E. (2015). Item non response and imputation strategies in SHARE Wave 5. In F. Malter, & A. Börsch-Supan (Eds.), SHARE Wave 5: Innovations & methodologies. Munich: MEA, Max Planck Institute for Social Law and Social Policy.
- Do, Y. K., Norton, E. C., & Stearns, S. C. (2013). Informal care and caregiver's health. Health Economics, 24(2), 224–237.
- Erreygers, G. (2009). Correcting the concentration index. Journal of Health Economics, 28, 504–515.
- Frick, J. R., & Ziebarth, N. R. (2013). Welfare-related health inequality: Does the choice of measure matter? The European Journal of Health Economics, 14, 431–442.
- García-Gómez, P., et al. (2015). Inequity in long-term care use and unmet need: Two sides of the same coin. Journal of Health Economics, 39, 147–158.
- Geyer, S., Spreckelsen, O., & von dem Knesebeck, O. (2014). Wealth, income, and health before and after retirement. Journal of Epidemiology & Community Health, 68(11), 1080–1087. Available at: https://doi.org/http://jech.bmj.com/cgi/doi/10.1136/jech-2014-203952
- Lindelow, M. (2006). Sometimes more equal than others: How health inequalities depend on the choice of welfare indicators. Health Economics, 15, 263–279.
- F. Malter, & A. Börsch-Supan (Eds) (2015). SHARE Wave 5: Innovations & methodology. Munich: MEA, Max Planck Institute for Social Law and Social Policy.
- Manski, R. J., et al. (2012). Wealth effect and dental care utilization in the United States. Journal of Public Health Dentistry, 72, 179–189.
- McCann, M., Donnelly, M., & O'Reilly, D. (2011). Living arrangements, relationship to people in the household and admission to care homes for older people. Age and Ageing, 40, 358–363.
- Muir, T. (2017). Measuring social protection for long-term care. OECD health working papers, 93.
- Norton, E. C. (2000). Long-term care. In A. J. Culyer, & J. P. Newhouse (Eds.), Handbook of health economics (Vol. 1) (pp. 956–994). Amsterdam, Lausanne, New York NY, Oxford, Shannon, Singapore, Tokyo: Elsevier Science B.V.
- O'Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2007). Analyzing health equity using household survey data. Washington DC: The World Bank.
10.1596/978-0-8213-6933-3 Google Scholar
- Organisation for Economic Co-operation and Development. (2011). Divided we stand: Why inequality keeps rising. Paris: Organisation for Economic Co-operation and Development.
- Organisation for Economic Co-operation and Development. (2013). OECD framework for statistics on the distribution of household income, consumption and wealth. Paris: Organisation for Economic Co-operation and Development.
- van Ourti, T. (2003). Socio-economic inequality in ill-health amongst the elderly. Should one use current or permanent income? Journal of Health Economics, 22, 219–241.
- Poterba, J.M., Venti, S.F. & Wise, D.A. (2010). The asset cost of poor health. NBER working papers, 16389.
- Rodrigues, R., Huber, M., & Lamura, G. (2012). Facts and figures on healthy ageing and long-term care: Europe and North America. Vienna: European Centre for Social Welfare Policy and Research.
- Schöllgen, I., Huxhold, O., & Tesch-Römer, C. (2010). Socioeconomic status and health in the second half of life: Findings from the German Ageing Survey. European Journal of Ageing, 7, 17–28.
- Van de Poel, E., van Doorslaer, E., & O'Donnell, O. (2012). Measurement of inequity in health care with heterogeneous response of use to need. Journal of Health Economics, 31(4), 676–689.
- van Doorslaer, E., Koolman, X., & Jones, A. M. (2004). Explaining income-related inequalities in doctor utilisation in Europe. Health Economics, 13(7), 629–647.
- Wagstaff, A., Paci, P., & van Doorslaer, E. (1991). On the measurement of inequalities in health. Social Science & Medicine, 33(5), 545–557.
- Wagstaff, A., & van Doorslaer, E. (2000). Measuring and testing for inequity in the delivery of health care. Journal of Human Resources, 35(4), 716–733.
- Wagstaff, A., & Watanabe, N. (2003). What difference does the choice of SES make in health inequality measurement? Health Economics, 12, 885–890.
