Vallejo-Torres, L.; (2012) An economic analysis of vertical equity in the delivery of health care in England. Doctoral thesis , UCL (University College London).

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Abstract

In this thesis we examine the overlooked issue of vertical equity in health care delivery. This principle requires that individuals with unequal needs receive appropriately unequal treatment. Most analyses of equity in health care delivery focus only on horizontal equity, i.e. the principle of equal treatment for equal needs. Therefore, the aim of this thesis is to assess and refine the techniques to investigate vertical inequity, and to offer evidence about vertical equity in the English health care system. The extent of inequalities in health is first investigated. We find persistent inequalities in health in England. We then illustrate the methods widely used in the literature to explore horizontal inequity in health care and highlight a major limitation; these studies ignore the possibility that the estimated differential treatment received by individuals with different needs is inappropriate. In order to identify the methods used to date to measure vertical equity we review the empirical literature. The most comprehensive techniques identified focused on the socioeconomic dimension of vertical inequity. We illustrate these techniques and suggest an extension to this measure that takes into account the full distribution of needs in a population. We apply our suggested methods to measure inequity in individual level and in area level health care provision in England. The optimal variation of health care with variation in needs is estimated based on subgroups less likely to be affected by unmet needs. The findings of this thesis indicate that there is vertical inequity in detriment to socioeconomic deprived groups and, to a larger extent, in detriment to those with larger needs. We show that including vertical inequity aspects may lead us to draw different conclusions about the nature and extent of inequity. Therefore, conclusions about inequities in health care are extensively being made on the basis of incomplete information.

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