Sometimes More Equal than Others : How Health Inequalities Depend on the Choice of Welfare Indicator

A large body of empirical work in recent years has focused on measuring and explaining socioeconomic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by per capita consumption or an asset index. Currently, there is only limited information on how the choice of welfare indicators affects the analysis of health inequalities and the incidence of public spending. Lindelow illustrates the potential sensitivity of the analysis of health-related inequalities to how socioeconomic status is measured. Using data from Mozambique, he focuses on five key health service indicators and tests whether measured inequality (concentration index) in the five health service variables is different depending on the choice of welfare indicator. He shows that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on measured inequality in health service utilization and on the perceived incidence of public spending. Consequently, one can reach very different conclusions about the quot;samequot; issue depending on how socioeconomic status is defined. The results call for more clarity and care in the analysis of health-related inequalities and for explicit recognition of the potential sensitivity of findings to the choice of welfare measure. The results also point to the need for more careful research on how different dimensions of socioeconomic status are related, and on the pathways by which these dimensions affect health-related variables.This paper - a product of Public Services, Development Research Group - is part of a larger effort in the group to strengthen the methodological underpinnings of equity analysis, and to better understand how the benefits of public spending in service delivery are distributed