Supplemental health insurance and equality of access in Belgium.

It has been suggested that the unequal coverage of different socio-economic groups by supplemental insurance could be a partial explanation for the inequality in access to health care in many countries. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. We find that this institutional background is crucial for the explanation of the effects of supplemental insurance. We find no evidence of adverse selection in the coverage of supplemental health insurance, but strong effects of socio-economic background. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights. This is in line with patterns of socio-economic stratification that have been well documented for Belgium. It is also in line with the regulation on extra-billing protecting patients in common rooms. For ambulatory care, we find a positive effect of supplemental insurance on visits to a dentist and on number of spells at a day centre but no effect on visits to a GP, on drugs consumption and on visits to a specialist.Costs; Cost; Risk; Policy; Choice; Insurance; Equality; Belgium;

Health and Income Across the Life Cycle and Generations in Europe

An age-cohort decomposition applied to panel data identifies how the mean, overall inequality and income-related inequality of self-assessed health evolve over the life cycle and differ across generations in 11 EU countries. There is a moderate and steady decline in mean health until the age of 70 or so and a steep acceleration in the rate of health deterioration beyond that age. In southern European countries and in Ireland, which have experienced the greatest changes in economic and social development, the average health of younger generations is significantly better than that of older generations. This is not observed in the northern European countries. In almost all countries, health is more dispersed among older generations indicating that Europe has experienced a reduction in overall health inequality over time. Although there is no consistent evidence that health inequality increases as a given cohort ages, this is true in the three largest countries – Britain, France and Germany. In the former two countries and the Netherlands, at least for males, the income gradient in health peaks around retirement age, as has been found for the US, but this pattern is not observed in the other countries. In most European countries, unlike the US, there is no evidence that income-related health inequality is greater among younger than older generations

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

Objectives: The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands. Study design: National quasi-experimental study. Methods: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. Results: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]). Conclusions: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions

Reducing socioeconomic health inequalities? A questionnaire study of majorization and invariance conditions

This data accompanies the paper Rohde KIM, Van Ourti T, Soebhag A (2023). "Reducing socioeconomic health inequalities? A questionnaire study of majorization and invariance conditions", Journal of Health Economics, DOI: 10.1016/j.jhealeco.2023.102773. This paper runs a lab experiment in order to study the appeal of basic preference conditions that underpin health inequality indices, including the widely used concentration index. We provide the data and code that allow for replication of the results in the paper. The file Readmefirst.pdf provides more details of the raw source data Final_Data.xlsx. The file replication.do can be run in STATA and replicates all results presented in the paper. Please let us know if you intend to use our data or STATA code

Measuring socio-economic inequality in illhealth using permanent income

In Belgium, income-related inequality in ill-health seems to favour the rich, meaning that the rich are generally in better health than the poor are. Restricting the analysis to subsamples of the Belgian population, slightly modifies the conclusion, i.e. there is no income-related inequality in ill-health among the 65+. Since it is not clear whether the absence in inequality stems from the limited variation in the income of the 65+ (because of welfare benefits) or whether it truly reflects reality, I did the analysis over again using estimates of permanent income instead of income. It turned out that inequality among the 65+ remained very limited indeed, yet robustness checks pointed to the fragility of the results.

Reducing socioeconomic health inequalities? A questionnaire study of majorization and invariance conditions

This data accompanies the paper Rohde KIM, Van Ourti T, Soebhag A (2023). "Reducing socioeconomic health inequalities? A questionnaire study of majorization and invariance conditions", Journal of Health Economics, DOI: 10.1016/j.jhealeco.2023.102773. This paper runs a lab experiment in order to study the appeal of basic preference conditions that underpin health inequality indices, including the widely used concentration index. We provide the data and code that allow for replication of the results in the paper. The file Readmefirst.pdf provides more details of the raw source data Final_Data.xlsx. The file replication.do can be run in STATA and replicates all results presented in the paper. Please let us know if you intend to use our data or STATA code.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Inequity in the face of death

We apply the theory of inequality in opportunity to measure inequity in mortality. Our empirical work is based on a rich dataset for the Netherlands (1998-2007), linking information about mortality, health events and lifestyles. We show that distinguishing between different channels via which mortality is affected is necessary to test the sensitivity of the results with respect to different normative positions. Moreover, our model allows for a comparison of the inequity in simulated counterfactual situations, including an evaluation of policy measures. We explicitly make a distinction between inequity in mortality risks and inequity in mortality outcomes. The treatment of this difference - “luck” - has a crucial influence on the results.status: publishe