Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지

Health Inequality Measurement in Korea Using EuroQo1-5 Dimension Valuation Weights

EuroQol-5 Dimension 건강가중치를 이용한 한국인의 건강수준의 형평성 측정

  • Published : 2008.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : Despite various government initiatives, including the expansion of national health insurance coverage, health inequality has been a key health policy issue in South Korea during the past decade. This study describes and compares the extent of the total health inequality and the income-related health inequality over time among Korean adults. Methods : This study employs the 1998, 2001 and 2005 Korean National Health and Nutrition Examination Surveys (KNHANESs). The self-assessed health (SAH) ordinal responses, measured on a five-point scale, resealed to cardinal values to measure the health inequalities with using interval regression. The boundaries of each threshold for the interval regression analysis were obtained from the empirical distribution of the EuroQol-5 Dimension (EQ-5D) valuation weights estimated from the 2005 KNHANES. The final model predicting the individuals' health status included age, gender, educational attainment, occupation, income, and the regional prosperity index. The concentration index was used to measure and analyze the health inequality. Results : The KNHANES data showed an unequal distribution of the total health inequality in favor of the higher income groups, and this is getting worse over time (0.0327 in 1998, 0.0393 in 2001 and 0.0924 in 2005). The income-related health inequality in 2005 was 0.0278, indicating that 30.1% of the total health inequality can be attributed to income. Conclusions : The findings indicate there are health inequalities across the sociodemographic and income groups despite the recent government's efforts. Further research is warranted to investigate what potential policy actions are necessary to decrease the health inequality in Korea.

Keywords

References

  1. Macinko JA, Starfield B. Annotated bibliography on equity in health, 1980-2001. Int J Equity Health 2002; 1(1): 1 https://doi.org/10.1186/1475-9276-1-1
  2. Choi BH, Roh YH, Yoon BS, Shin HW, Kim MH, Kim CY. Measuring Inequity in Health Care and Policy Proposals in Korea. Seoul: Korea Institute for Health and Social Affairs; 2007. (Korean)
  3. Kim CY, Kim MH. Equity of Health Status and Medical Utilization in Korea. In: Choi JS, editor. Health Behavior and Disease Pattern in Korea- Analysis of Korea National and Nutrition Examination Survey 2001. Seoul: Ministry of Health and Social Welfare, Korea Institute for Health and Social Affairs; 2003, p.477-481. (Korean)
  4. Mun SH. Equity in the finance and delivery of health care. Korean Soc Secur Stud 2004; 20(1): 59-81. (Korean)
  5. van Doorslaer E, Wagstaff A, Bleichrodt H, Calonge S, Gerdtham UG, Gerfin M, et al. Income-related inequalities in health: Some international comparisons. J Health Econ 1997; 16(1): 93-112 https://doi.org/10.1016/S0167-6296(96)00532-2
  6. van Doorslaer E, Jones AM. Income-related inequality in health and health care in the European Union. Health Econ 2004; 13(7): 605- 608 https://doi.org/10.1002/hec.917
  7. van Doorslaer E, Koolman X. Explaining the differences in income-related health inequalities across European countries. Health Econ 2004; 13(7): 609-628 https://doi.org/10.1002/hec.918
  8. van Doorslaer E, Jones AM. Inequalities in selfreported health: Validation of a new approach to measurement. J Health Econ 2003; 22(1): 61-87 https://doi.org/10.1016/S0167-6296(02)00080-2
  9. Khang YH, Lynch JW, Yun S, Lee SI. Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health 2004; 58(4): 308-314 https://doi.org/10.1136/jech.2003.012989
  10. Jee SH, Ohrr HC, Kim IS. Self rated health and mortality in elderly Kangwha cohort, 8-year follow up. Korean J Epidemiol 1994; 16(2): 172-180. (Korean)
  11. Kweon SS, Kim SY, Im JS, Sohn SJ, Choi JS. Self-rating perceived health: The influence on health care utilization and death risk. Korean J Prev Med 1999; 32(3): 355-360. (Korean)
  12. Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav 1997; 38(1): 21-37 https://doi.org/10.2307/2955359
  13. van Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, De Graeve D, Duchesne I, et al. Equity in the delivery of health care in Europe and the US. J Health Econ 2000; 19(5): 553-583 https://doi.org/10.1016/S0167-6296(00)00050-3
  14. Bound J. Self-reported versus objective measures of health in retirement models. J Hum Resour 1991; 26(1): 139-153 https://doi.org/10.2307/145719
  15. Crossley TF, Kennedy S. The reliability of selfassessed health status. J Health Econ 2002; 21(4): 643-658 https://doi.org/10.1016/S0167-6296(02)00007-3
  16. Kerkhofs M, Lindeboom M. Subjective health measures and state dependent reporting errors. Health Econ 1995; 4(3): 221-235 https://doi.org/10.1002/hec.4730040307
  17. Groot W. Adaptation and scale of reference bias in self-assessments of quality of life. J Health Econ 2000; 19(3): 403-420 https://doi.org/10.1016/S0167-6296(99)00037-5
  18. Sadana R, Mathers CD, Lopez AD, Murray CJ, Iburg K. Comparative Analysis of more than 50 Household Surveys on Health Status. Geneva: WHO; 2007. (GPE Discussion Paper No. 15.)
  19. Hernandez-Quevedo C, Jones AM, Rice N. Reporting Bias and Heterogeneity in Selfassessed Health. Evidence from the British Household Panel Survey: ECuity project III Group working Paper #19; 2004
  20. Lecluyse A. Income-related health inequality in Belgium: A longitudinal perspective. Eur J Health Econ 2007; 8(3): 237-243 https://doi.org/10.1007/s10198-006-0024-3
  21. Retana LF, Jones AM. Inequalities in Selfassessed Health in the Health Survey of England. ECuity Project III Working Paper #11; 2003
  22. Leu RE, Schellhorn M. The Evolution of Income-Related Health Inequalities in Switzerland over Time. ECuity Project III Working Paper #22; 2004
  23. van Doorslaer E, Gerdtham UG. Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data. Soc Sci Med 2003; 57(9): 1621-1629 https://doi.org/10.1016/S0277-9536(02)00559-2
  24. KOSIS: Korea Statistical Information System [Internet]. Dependency raio. Aged-child ration, and Meadian age of Korea. Daejeon: Korea National Statistical Office. 2007. [cited 2007 Feb 16] . Available from: URL:http://www. kosis.co.kr
  25. Kang EJ, Shin HS, Park HJ, Kim NY. A valuation of health status using EQ-5D. Korean J Health Econ Policy 2006; 12(2):19-43. (Korean)
  26. Jo MW. Estimating Quality Weights for EQ- 5D Health States with Time Trade-Off Methods in South Korea [dissertation]. Korea: Univ Ulsan; 2005. (Korean)
  27. Kakwani N, Wagstaff A, van Doorslaer E. Socioeconomic inequalities in health: Measurement, computation, and statistical inference. J Econometr 1997; 77(1): 87-103 https://doi.org/10.1016/S0304-4076(96)01807-6
  28. Koolman X, van Doorslaer E. On the interpretation of a concentration index of inequality. Health Econ 2004; 13(7): 649-656 https://doi.org/10.1002/hec.884
  29. Blackburn ML. Interpreting the magnitude of changes in measures of income inequality. J Econ 1989; 42(1): 21-25 https://doi.org/10.1016/0304-4076(89)90072-9
  30. Kim HR, Khang YH, Yoon KJ, Kim CS. Socioeconomic Health Inequalities and Counter Policies in Korea. Seoul: Korea Institute for Health and Social Affairs; 2004. (Korean)
  31. Kim HR, Khang YH, Park EJ, Choi JS, Lee YH, Kim YS. Socioeconomic, Behavioral, Nutritional, and Biological Determinants of Morbidity, Mortality, and Medical Utilization in South Korea-Analysis of Korea National and Nutrition Examination Survey(KNHANES) Linked Data. Seoul: Korea Institute for Health and Social Affairs; 2007. (Korean)
  32. Kang SW, Kim JW, Kim TW, Choi HS, Lim WS. Change in Poverty and Inequality-related Indicators in Korea. Seoul: Korea Institute for Health and Social Affairs; 2007. (Korean)
  33. Martikainen P, Lahelma E, Marmot M, Sekine M, Nishi N, Kagamimori S. A comparison of socioeconomic differences in physical functioning and perceived health among male and female employees in Britain, Finland and Japan. Soc Sci Med 2004; 59(6): 1287-1295 https://doi.org/10.1016/j.socscimed.2004.01.005
  34. MacIntyre S, Hunt K. Socio-economic position, gender and health: How do they interact? J Health Psychol 1997; 2(3): 315-334 https://doi.org/10.1177/135910539700200304
  35. Mustard CA, Etches J. Gender differences in socioeconomic inequality in mortality. J Epidemiol Community Health 2003; 57(12): 974-980 https://doi.org/10.1136/jech.57.12.974
  36. Artazcoz L, Borrell C, Benach J. Gender inequalities in health among workers: The relation with family demands. J Epidemiol Community Health 2001; 55(9): 639-647 https://doi.org/10.1136/jech.55.9.639
  37. Matthews S, Manor O, Power C. Social inequalities in health: Are there gender differences? Soc Sci Med 1999; 48(1): 49-60 https://doi.org/10.1016/S0277-9536(98)00288-3
  38. Thurston RC, Kubzansky LD, Kawachi I, Berkman LF. Is the association between socioeconomic position and coronary heart disease stronger in women than in men? Am J Epidemiol 2005; 162(1): 57-65 https://doi.org/10.1093/aje/kwi159
  39. Honjo K, Kawakami N, Takeshima T, Tachimori H, Ono Y, Uda H, et al. Social class inequalities in self-rated health and their gender and age group differences in Japan. J Epidemiol 2006; 16(6): 223-232