Jiménez-Rubio Dolores, Smith Peter C, Van Doorslaer Eddy
Department of Economics and Related Studies, University of York, York, UK.
Health Econ. 2008 Mar;17(3):377-92. doi: 10.1002/hec.1272.
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.
行政分权对卫生与医疗保健公平性的影响是卫生政策辩论中一个重要的未决问题。有限的理论文献和相关实证研究所得出的预测都不足以得出任何确凿结论。然而，许多国家在缺乏研究证据的情况下仍在试验分权政策。本文通过调查加拿大这一高度分权环境中与健康相关公平性的空间维度，对分权进行了探索性实证分析。利用2001年加拿大社区健康调查的数据，我们应用集中指数分解法来探究健康方面与收入相关的不平等以及医疗保健使用方面的不公平现象，更有可能是由于加拿大贫富省份之间的差距，而非各省内部贫富个体之间的差异所致。结果表明，地区内部差异是与收入相关的健康不平等的最重要来源，而医疗保健使用方面与收入相关的不公平现象主要是由各省之间的差异造成的。
