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Inequalities in HealthConcepts, Measures, and Ethics$
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Nir Eyal, Samia A. Hurst, Ole F. Norheim, and Dan Wikler

Print publication date: 2013

Print ISBN-13: 9780199931392

Published to Oxford Scholarship Online: January 2014

DOI: 10.1093/acprof:oso/9780199931392.001.0001

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Atkinson’s Index Applied to Health

Atkinson’s Index Applied to Health

Can Measures of Economic Inequality Help Us Understand Tradeoffs in Health Care Priority Setting?

(p.214) 14 Atkinson’s Index Applied to Health
Inequalities in Health

Ole F. Norheim

Oxford University Press

Some authors have suggested that inequality in health at population level could be explored by using inequality measures derived from measurement of income inequality. Would it make sense to substitute income with health in measures such as the Gini or Atkinson’s index of inequality? The aim of this chapter is to explore if Atkinson’s index of inequality can help us understand trade-offs in health care priority setting, and if yes, how to respond to possible objections to this use. Measures of economic inequality can help us understand trade-offs in health care priority setting. I argue that Atkinson’s index of inequality and the achievement index are able to: a) capture distributive concerns in cases involving inequality in the age of death; b) measure impact of population level interventions (e.g. targeting under-five mortality); c) capture distributive concerns for the worst off; and d) provide an alternative perspective on the disability paradox encountered by cost-utility analysis. Limitations to this approach include distributions involving small health benefits at the beginning of life (the incomplete lives argument) and at the end of life (a special concern for palliative care for terminally ill patients regardless of how much health they have achieved previously). The univariate measures discussed in this paper is only concerned with the distribution of health itself. Additional and normatively relevant types of information are captured in bivariate and multivariate measures.

Keywords:   inequality in health, univariate measures of inequality, gini, atkinson’s index, priority setting, concern for the worst off, disability and priority setting

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