Siegel Martin, Vogt Verena, Sundmacher Leonie
Berlin Centre of Health Economics Research, Department of Health Care Management, Technische Universität Berlin, H80, Straße des 17. Juni 135, 10623 Berlin, Germany.
Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-Universität München, Schackstraße 4, 80539 Munich, Germany.
Soc Sci Med. 2014 May;108:10-9. doi: 10.1016/j.socscimed.2014.02.022. Epub 2014 Feb 13.
Individual socio-economic status and the respective socio-economic and political contexts are both important determinants of health. Welfare regimes may be linked with health and health inequalities through two potential pathways: first, they may influence the associations between socio-economic status and health. Second, they may influence the income-related distributions of socio-economic determinants of health within a society. Using the Socio-Economic Panel (SOEP) for the years 1994-2011, we analyze how income-related health inequalities evolved in the context of the transformation from a conservative to a liberal welfare system in Germany. We use the concentration index to measure health inequalities, and the annual concentration indices are decomposed to reveal how the contributions of the explanatory variables age, sex, income, education, and occupation changed over time. The changes in the contributions are further decomposed to distinguish whether changes in health inequalities stem from redistributions of the explanatory variables, from changes in their associations with health, or from changes in their means. Income-related health inequalities to the disadvantage of the economically deprived roughly doubled over time, which can largely be explained by changes in the contributions of individual characteristics representing weaker labor market positions, particularly income and unemployment. The social and labor market reforms coincide with the observed changes in the distributions of these characteristics and, to a lesser extent, with changes of their associations with health.
个人社会经济地位以及各自的社会经济和政治背景都是健康的重要决定因素。福利制度可能通过两条潜在途径与健康及健康不平等相联系：其一，它们可能影响社会经济地位与健康之间的关联。其二，它们可能影响社会中与健康相关的社会经济决定因素在收入方面的分布情况。利用1994年至2011年的社会经济面板数据（SOEP），我们分析了在德国从保守型福利体系向自由型福利体系转变的背景下，与收入相关的健康不平等是如何演变的。我们使用集中指数来衡量健康不平等，并对年度集中指数进行分解，以揭示解释变量年龄、性别、收入、教育和职业的贡献是如何随时间变化的。对贡献的变化进一步分解，以区分健康不平等的变化是源于解释变量的重新分配、它们与健康关联的变化，还是其均值的变化。随着时间推移，经济上处于劣势的人群在与收入相关的健康不平等方面大致增加了一倍，这在很大程度上可以由代表较弱劳动力市场地位的个体特征（特别是收入和失业）的贡献变化来解释。社会和劳动力市场改革与这些特征分布的变化相吻合，并且在较小程度上与它们和健康关联的变化相吻合。
