Socioeconomic status and medical expenditures

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Socio-economic status and medical expenditures
Health Systems Research, Public Health School, UCL
Vincent Lorant
June 2002
Health System Research, Public Health School,
Université Catholique de Louvain
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Objective

• Why and how socio-economic status (SES) should
  be considered in risk adjustement model ?

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Contents

• Rationale for SES adjustement fairness and
  quality
• International review of SES adjustement
• Methodological consideration
• Indicators to be used

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Why adjust for socio-economic status ?

• Horizontal equity SES catches unobserved
  differences in health
• Vertical equity differences in ability to pay.
• SES influence the bundle of care
• For given use of care, lower SES individuals have
  a poorer health outcome

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What other countries do ?

• In a recent international review 10 countries out
  of 20 included some SES adjustement
• Employment and welfare had the edge
• 8 countries adjusted for geographical features
• SES weights are similar to the morbidity weights
  in the British formula

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How to adjust for SES ?

• Separate the income effect from the deprivation
  effect
• Poor relevance of observed pattern of care to
  model capitation formulae
• SES at the ecological level should be considered
• Availability of data is a weak argument

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• Summarize your points.
• State your conclusion. Make it relevant to your
  audience.

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Spatial autocorrelation of socio-economic status,
health and health care 589 Belgian
municipalities
Source Lorant, Social Science and Medicine, 2001
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Which SES indicator to use ?

• Continuous prefered to binary
• Time-invariant
• Applying to active and inactive
• Assessing status and deprivation
• Educational status and deprivation are good
  choices

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Recommendations

• The formula should be designed on expected care
  or on the least unequitable type of care
• Use more valid and continous SES indicators
• Models should consider spatial clustering
• Models aiming not only to avoid cream- skimming
  but also to promote quality of care