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cover page image Horizontal equity in health care utilization - evidence from three high-income Asian economies.

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Lu, Jui-fen Rachel, Gabriel M. Leung, Soonman Kwon, Keith YK Tin et al.
1 May 2005 | 25 pages

Abstract: Employing consistent methods, we examine the degree to which the principle of “equal treatment for equal need”(ETEN) is maintained in Hong Kong, South Korea and Taiwan.
Deviation in the degree to which health care is distributed according to need is measured by an index of horizontal inequity. This is a measure of income-related inequality in the utilization of health care after standardizing for differences in need. Inequality in utilization is decomposed into four major sources:- i) income ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms) iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits as well as inpatient admissions.
Violations of the ETEN principle were most frequently observed in Hong Kong (all service types except for ER visits), whereas South Korea appeared to have maintained ETEN across all service types examined. Taiwan showed intermediate results in that the better-off were more likely to use outpatient services (controlling for need), but quantities of western doctor and dental visits were evenly distributed while there was pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions were either proportional or slightly pro-poor.
Future work should focus on developing, implementing and evaluating policy interventions to reduce the observed unequal distributions in these three economies, in addition to the urgent and rigorous examination of horizontal equity elsewhere in Asia.