School of Health Administration, Dalhousie University, Halifax, NS, Canada.
Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada.
Eur J Health Econ. 2020 Mar;21(2):171-180. doi: 10.1007/s10198-019-01118-2. Epub 2019 Sep 21.
Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and explains inequity which is based on regression analysis, the concentration index, and the decomposition technique. However, this method is not beyond limitations and criticisms, and it has been subject to several methodological challenges in the past decade. This review presents a summary of the recent developments and debates on various methodological issues and their implications on the assessment of HI in healthcare utilisation. We discuss the key disputes centred on measurement scale of healthcare variables as well as the evolution of the decomposition technique. We also highlight the issues about the choice of variables as the indicator of SES in measuring inequity. This follows a discussion on the application of the longitudinal method and use of administrative data to quantify inequity. Future research could exploit the potential for health administrative data linked to social data to generate more comprehensive estimates of inequity across the healthcare continuum. This review would be helpful to guide future applied research to examine inequity in healthcare utilisation.
医疗保健中的公平性是世界上许多医疗保健系统的总体目标。对医疗保健利用公平性的实证研究主要依赖于水平不公平（HI）方法，该方法衡量了在同等医疗需求下，社会经济地位（SES）对医疗保健服务利用的不平等程度。HI 方法通过回归分析、集中指数和分解技术来检验、量化和解释不公平现象。然而，这种方法并非没有局限性和批评，在过去十年中，它已经受到了一些方法学挑战的影响。本综述总结了最近在医疗保健利用中 HI 评估的各种方法问题及其影响的研究进展和争论。我们讨论了以医疗保健变量的度量尺度为中心的关键争议，以及分解技术的演变。我们还强调了在衡量不公平程度时，SES 指标选择变量的问题。接下来讨论了纵向方法的应用和使用行政数据来量化不公平现象。未来的研究可以利用与社会数据相关联的健康行政数据的潜力，在整个医疗保健连续体中生成更全面的不公平估计。本综述将有助于指导未来的应用研究，以检验医疗保健利用中的不公平现象。
