ON THE CHOICE OF HEALTH INEQUALITY MEASURE FOR THE LONGITUDINAL ANALYSIS OF INCOME‐RELATED HEALTH INEQUALITIES

Changes in rank‐dependent income‐related health inequality measures over time may usefully be decomposed into contributions due to changes in health outcomes and changes in individuals' positions in the income distribution. This paper establishes the normative implications of this type of decomposition by embedding it within a broader analysis of changes in the ‘health achievement’ index. We further show that the choice of health inequality measure implies a particular vertical equity judgement, which may be expressed on a common scale in terms of the concentration index of health changes that would be inequality preserving. We illustrate the empirical implications of this choice by reporting results from a longitudinal analysis of changes in income‐related health inequality in Great Britain using the concentration, the Erreygers and Wagstaff indices of health attainments and the concentration index of health shortfalls. Copyright © 2012 John Wiley & Sons, Ltd.     

PARENTAL INCOME AND THE DYNAMICS OF HEALTH INEQUALITY IN EARLY CHILDHOOD—EVIDENCE FROM THE UK

Recent research documents that socioeconomic health inequality has its origins in early childhood, that is, children from high‐income families have better health than their peers from low‐income families. In this article, we investigate the determinants of the evolution of socioeconomic health inequality in the UK. We analyze the relation between household income and both the prevalence and the consequences of adverse health conditions by following up infants throughout early childhood. We find evidence for the hypothesis that parental income operates through two different channels: it reduces the likelihood of incurring certain illnesses and it cushions the consequences of health conditions. Our results also indicate that a higher household income increases the probability that children fully recover from some diseases within a given period. Copyright © 2012 John Wiley & Sons, Ltd.     

SEMIPARAMETRIC MODELING OF AGE‐SPECIFIC VARIATIONS IN INCOME RELATED HEALTH INEQUALITIES

A Gini‐type concentration index is combined with semiparametric estimation techniques to derive a varying inequality index that works without a priori sample stratification. The new approach is used to investigate the question how income inequalities and income‐related gradients in the distribution of health vary across age groups. With health data from the 2005 survey of the German microcensus, it is demonstrated that significant inequalities to the detriment of the deprived evolve in early mid‐life and reach their maximum around the age for retirement. Some leveling is found for the elderly. Copyright © 2013 John Wiley & Sons, Ltd.     

INCREASING OUR UNDERSTANDING OF THE HEALTH‐INCOME GRADIENT IN CHILDREN

There have been numerous attempts to both document the income‐health gradient in children and to understand the nature of the tie. In this paper, we review and summarize existing studies, and then use a unique school‐based panel data set from the USA to attempt to further our understanding of the relationship. The long duration (5 observations, 9 years) allows us to add to the understanding of the pattern of the tie, through our ability to test for changes in health status and multiple measures of income, and the school‐based nature of the data allow us to add community socioeconomic status to the model. Increasing understanding of the income‐health gradient has clear policy implications in terms of effective targeting of interventions to decrease the gradient and hence decrease health disparities among children. Copyright © 2013 John Wiley & Sons, Ltd.     

UNDERSTANDING THE VERTICAL EQUITY JUDGEMENTS UNDERPINNING HEALTH INEQUALITY MEASURES

The choice of income‐related health inequality measures in comparative studies is often determined by custom and analytical concerns, without much explicit consideration of the vertical equity judgements underlying alternative measures. This note employs an inequality map to illustrate how these judgements determine the ranking of populations by health inequality. In particular, it is shown that relative indices of inequality in health attainments and shortfalls embody distinct vertical equity judgments, where each may represent ethically defensible positions in specific contexts. Further research is needed to explore people's preferences over distributions of income and health. Copyright © 2013 John Wiley & Sons, Ltd.     

上海市松江区流动人口健康相关行为调查

[目的]了解松江区流动人口健康相关行为状况及影响因素,以有效开展针对性的干预活动,提高流动人口的健康水平。[方法]通过流行病学现况调查,对564名研究对象进行问卷调查。[结果]564名研究对象中,95.57%的流动人口平常饮用开水;经常吃冷食品的流动人口仅占4.96%,87.23%的流动人口家里能够做到经常开窗通风,77.80%的流动人口能够做到饭前便后经常洗手。38.43%的对象表示平时不会注意传染病的防治,33.09%的对象对传染病知识宣传持无所谓态度。定期体检和生病后及时就诊的比例也仅分别为28.83%和54.03%。分析结果显示,研究对象的年龄、性别、文化程度及家庭月收入对流动人口的健康相关行为产生影响。[结论倡导健康卫生生活方式,加强宣传教育和多部门合作,提高服务和宣教的针对性,促进流动人口的身心健康。     

A DUAL ATKINSON MEASURE OF SOCIOECONOMIC INEQUALITY OF HEALTH

The Atkinson index of income inequality is based on a comparison of the average income with the equivalent income, where the equivalent income is defined as the level of income that, if given to everyone, would generate the same social welfare as the existing distribution of income. This paper explores the possibility of extending this approach to the measurement of socioeconomic inequality of health. It assumes a social evaluation function that depends upon two variables: socioeconomic status as well as health status. With a general form of this function, an Atkinson measure is derived, which gives exactly the same result when applied to the socioeconomic variable and when applied to the health variable. The paper examines the properties of the index and suggests various extensions. Copyright © 2012 John Wiley & Sons, Ltd.     

ON THE CARDINAL MEASUREMENT OF HEALTH INEQUALITY WHEN ONLY ORDINAL INFORMATION IS AVAILABLE ON INDIVIDUAL HEALTH STATUS

This paper suggests new indices of health inequality which may be used when only ordinal information is available on individual health status. We borrow ideas from the literature on the measurement of occupational or residential segregation and show that indices of ordinal segregation which have been recently proposed may be also applied to the measurement of health inequality. We also prove that these indices satisfy four axioms introduced to measure inequality with ordered response health data so that the new indices presented in this paper are consistent with the inequality ordering proposed by Allison and Foster. We also suggest an extension of the family of indices proposed by Abul Naga and Yalcin. Copyright © 2011 John Wiley & Sons, Ltd.     

兵器试验参与人员心理健康状况及影响因素

目的 调查兵器试验参与人员心理健康状况及影响因素,为制定干预对策、提高参与人员心理健康水平提供依据.方法 采用症状自评量表(SCL-90)、应激水平量表和访谈的方法,对某兵器试验单位390名参与人员心理健康特点及其影响因素进行调查与分析.结果 问卷结果显示,兵器试验参与人员SCL-90总分及躯体化、焦虑、强迫症状、人际关系敏感、抑郁、敌对因子分均明显高于非参与人员,差异有显著性(P＜0.05,P＜0.01).民主型管理方式、和睦的工作氛围和良好的人际关系中应激分数、SCL-90均分最低,差异有显著性(P＜0.05,P＜0.01).访谈显示,15名SCL-90得分较低的参与者认为,组织内部公平、在本单位有自豪感、信息公开透明、能够开放地讨论问题、得到同事和领导的尊重、个人才能得到发挥等条目所占百分比均高于另外15名SCL-90得分较高者,差异有显著性(P＜0.05).结论 兵器试验参与人员心理健康水平较非参与人员低,心理健康状况与工作环境、管理模式、工作氛围、人际关系等密切相关.     

农村3岁以下儿童健康影响因素分析

对四川仁寿县4个乡7岁以下的儿童进行健康普查,发现3岁以下儿童三种营养性疾病和两种常见病(肺炎、腹泻)的发病率高于其它年龄儿童,随机抽出3岁以下儿童584例进行健康影响因素的调查。结果表明:出生体重小于2.5kg,四月内非母乳喂养,母亲文盲,出生产次>3次等因素对小儿的上述疾病分别有所影响,且上述疾病及这些影响因素与小儿现体重关系密切。     

城市流动儿童看护人的儿童保健认知现状调查

[目的]了解杭州和北京两城市5岁以下流动儿童看护人的儿童保健认知现状,从而有利于制定针对性的干预措施。[方法]在杭州市下城区和北京市朝阳区、大兴区选取流动人口居住比例高的地区对所有符合条件的5岁以下流动儿童看护人进行问卷调查。[结果]共收集到3028份5岁以下流动儿童看护人有效问卷。杭州流动儿童看护人的儿童保健认知水平要好于北京流动儿童看护人。但关于孩子6个月应该适时添加辅食的回答正确率在两地分别为27.9%和22.2%,能列举3种及以上儿童疾病或危险信号的比例分别为34.6%和17.0%。[结论]杭州和北京城市流动儿童看护人对某些儿童保健知识,特别是儿童添加辅食月份和儿童危险或疾病信号的知晓率还较低。因此,需要对流动儿童看护人尤其低文化程度看护人进行健康教育和干预以提高其儿童保健知识和态度。     

社会性别与大学生艾滋病健康教育

[目的]了解男女大学生关于艾滋病的知识、态度及婚前性行为相关认知现状的差异,在社会性别视角下分析造成差异的可能原因,为有效开展大学生艾滋病的健康教育提供科学依据。[方法]采用分层随机抽样的方法,对成都市某重点高校一年级至三年级790名大学生进行问卷调查。[结果]男女生对艾滋病的基本知识知晓率都比较高,男女间差异无统计学意义(t=0.410,P﹥0.05);部分学生对艾滋病传播途径存在误解,男女间差异有统计学意义(2χ=6.822、9.542、10.68、8.792,P﹤0.05),男生知晓率高于女生;调查对象中有53.2%的男生和56%的女生表示同情艾滋病感染者或艾滋病病人,性别间差异无计学意义(2χ=6.314,P﹥0.05);男生对婚前性行为持反对态度的占19.7%,持赞同或无所谓态度的占80.3%;女生分别占6.3%、93.7%,性别间差异有统计学意义(2χ=62.457,P﹤0.01)。[结论]男女大学生在艾滋病预防知识以及婚前性行为及其认知现状方面存在差异。因此大学生艾滋病健康教育必须考虑性别差异,并与性健康教育相结合,有针对性的开展健康教育活动,对大学生的性行为进行正确的引导,从而有效的同时提高男女生的艾滋病知识水平并促进其态度行为改变。     

THE EFFECT OF NATIONAL HEALTH INSURANCE ON MORTALITY AND THE SES–HEALTH GRADIENT: EVIDENCE FROM THE ELDERLY IN TAIWAN

Using the difference‐in‐difference‐in‐differences method, we examine the effect of the National Health Insurance (NHI) on mortality, self‐assessed health, and functional limitations of the elderly and seek to determine whether the effect is spread equally across health classes. We find that the NHI only has an effect on the death hazard, and it is the least healthy who benefit the most. The death hazard falls by 16–48% and 3–9% for the least health and the healthiest, respectively. The decline in the hazard ratio for the least healthy among the uninsured is 58% greater than that of their counterparts among the insured. Moreover, female participants benefit more from the NHI than male participants. We find no significant effect of the NHI in the SES–health gradient except for the education–death hazard gradient. The gap in the education‐death hazard gradient between the insured and previously uninsured is significantly reduced by 7–31% after 1995. The hazard ratio among the less‐educated in the treatment group also falls by 55% relative to that in the comparison group. The NHI appears to have prolonged lives but has failed to improve the functional limitations, which might have contributed to the rapid increase in the demand for long‐term caregivers in recent years. Copyright © 2012 John Wiley & Sons, Ltd.     

INCOME‐RELATED INEQUITY IN HEALTHCARE UTILISATION AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN ENGLAND—ACCOUNTING FOR VERTICAL INEQUITY

Economic analyses of equity which focus solely on horizontal inequity offer a partial assessment of socioeconomic inequity in healthcare use. We analyse income‐related inequity in cardiovascular disease‐related healthcare utilisation by individuals reporting cardiovascular disease in England, including both horizontal and vertical aspects. For the analysis of vertical inequity, we use target groups to estimate the appropriate relationship between healthcare needs and use. We find that including vertical inequity considerations may lead us to draw different conclusions about the nature and extent of income‐related inequity. After accounting for vertical inequity in addition to horizontal inequity, there is no longer evidence of inequity favouring the poor for nurse visits, whereas there is some evidence that doctor visits and inpatient stays are concentrated among richer individuals. The estimates of income‐related inequity for outpatient visits, electrocardiography tests and heart surgery become even more pro‐rich when accounting for vertical inequity. Copyright © 2012 John Wiley & Sons, Ltd.     

THE EFFECT OF DIABETES COMPLICATIONS ON HEALTH‐RELATED QUALITY OF LIFE: THE IMPORTANCE OF LONGITUDINAL DATA TO ADDRESS PATIENT HETEROGENEITY

We estimate the impact of six diabetes‐related complications (myocardial infarction, ischaemic heart disease, stroke, heart failure, amputation and visual acuity) on quality of life, using seven rounds of EQ‐5D questionnaires administered between 1997 and 2007 in the UK Prospective Diabetes Study. The use of cross‐sectional data to make such estimates is widespread in the literature, being less expensive and easier to collect than repeated‐measures data. However, analysis of this dataset suggests that cross‐sectional analysis could produce biased estimates of the effect of complications on QoL. Using fixed effects estimators, we show that variation in the quality of life between patients is strongly influenced by time‐invariant patient characteristics. Our results highlight the importance of studying quality‐of‐life changes over time to distinguish between time‐invariant determinants of QoL and the effect on QoL of specific events such as diabetes complications. © 2013 The Authors. Health Economics Published by John Wiley & Sons Ltd.     

住院病人健康教育知晓率的相关因素调查研究

目的　对影响住院病人健康教育知晓率的相关因素进行分析。方法　自行设计调查表 ,对住院病人的一般资料、健康教育内容、护士行为等进行调查 ,所得数据进行统计学处理。结果　经单一因素统计分析 ,病人的职业、付费类别、住院次数、经济状况、护士的健康教育方式、态度和行为对住院病人健康教育知晓率的影响有统计学意义 (P <0 0 5 ) ;经多因素逐步回归分析 ,从中筛选出住院次数、护士行为、态度及宣教方式对健康教育有明显影响。结论　在进行健康教育时要重视宣教方式和护士行为、态度对健康教育的影响。     

基层妇幼保健医务工作者自测健康状况调查

[目的]了解基层妇幼保健医务工作者的自测健康状况,为基层妇幼卫生保健管理提供参考依据.[方法]应用自测健康评定量表(SRHMS)对深圳市福田区1家二甲医院和8家社区健康服务中心122名妇幼保健医务工作者与200名一般人群同时进行自测健康调查,所测数据用SPSS10.0进行统计学处理,并对其影响因素进行分析.[结果]基层妇幼保健医务工作者普遍对自我健康状况评价和健康期望评分较低.在身体症状与器官功能、心理症状和负向情绪因素方面,与一般人群相比评分较低,差异有统计学意义;而在角色活动与社会适应、社会资源与社会接触等因素上的自我评分要高于一般人群,差异有统计学意义.[结论]基层妇幼保健医务工作者的自测健康状况较差.医疗机构有必要定期开展医护人员健康教育、建立个体心理健康辅导机制、并通过各种形式的社会互动以增加社会支持.     

北京某科研院所人员生存质量调查结果分析

[目的]对北京中关村地区某科研单位人群进行生存质量测量,评价其生存质量和健康状况,分析影响生存质量的因素,以便有针对性地开展健康指导. [方法]采用世界卫生组织推荐WHOQOL-100量表对该单位285名职工和研究生进行自填式调查,由研究人员统一发放问卷. [结果]问卷回收率95.4%,该人群在生存质量24个方面中记分最低为"对药物及医疗手段的依赖性",其次为"消极感受"和"疼痛与不适";6大领域中,独立性领域得分最高,精神支柱/宗教/个人信仰得分最低. [结论]该人群生存质量得分特点为对药物和医疗手段的依赖性、消极感受和疼痛与不适得分最低.经分析年龄因素对生存质量有影响,31～45岁组应重点给予健康关注,对知识分子人群尤其是中青年人群应采取措施舒解工作压力,培养其健康意识以提高生存质量,预防慢性病的发病.     

VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE

Using data from Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate the determinants of voluntary private health insurance (VPHI) among the over 50s in 11 European countries and their effects on healthcare spending. First, we find that the main determinants of VPHI are different in each country, reflecting differences in the underlying healthcare systems, but in most countries, education levels and cognitive abilities have a strong positive effect on holding a VPHI policy. We also analyse the effect of holding a voluntary additional health insurance policy on out‐of‐pocket (OOP) healthcare spending. We adopt a simultaneous equations approach to control for self‐selection into VPHI policy holding and find that, only in the Netherlands, VPHI policyholders have lower OOP spending than the rest of the population, whereas in some countries (Italy, Spain, Denmark and Austria), they spend significantly more. This could be due to not only increased utilisation but also cost‐sharing measures adopted by the insurers to counter the effects of moral hazard and to keep adverse selection under control. Copyright © 2012 John Wiley & Sons, Ltd.