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Equity in health and health care in a decentralised context: evidence from Canada
Author(s) -
JiménezRubio Dolores,
Smith Peter C.,
Van Doorslaer Eddy
Publication year - 2008
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.1272
Subject(s) - decentralization , equity (law) , health equity , public economics , health care , health policy , inequality , context (archaeology) , economics , economic growth , business , political science , geography , mathematical analysis , mathematics , archaeology , law , market economy
The impact of administrative decentralisation on equity in health and health care is an important unresolved issue in the health policy debate. Predictions from the limited theoretical literature and the relevant empirical research are both insufficient to draw any firm conclusions. Many countries are nevertheless experimenting with decentralisation policies in the absence of research evidence. This paper presents an exploratory empirical analysis of decentralisation by investigating the spatial dimensions of health‐related equity in Canada, a highly decentralised setting. Using data from the 2001 Canadian Community Health Survey , we apply a decomposition method of the Concentration Index to explore whether income‐related inequalities in health and inequities in the use of health care are more likely to be due to gaps between rich and poor Canadian provinces rather than to differences between rich and poor individuals within them. The results show that within area variation is the most important source of income‐related health inequality, while income‐related inequities in health care use are mostly driven by differences between provinces. Copyright © 2007 John Wiley & Sons, Ltd.