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An economic analysis of vertical equity in the delivery of health care in England

PhD Project funded by: MRC Capacity Building Studentship

October 2008-September 2011

Key contact: Laura Vallejo-Torres
Supervisor: Professor Steve Morris

Equity is an important policy objective in many health care systems. Much of the empirical work on equity in the delivery of health care has concentrated on the notion of ‘equal treatment for equal need’ which has been defined as horizontal equity. Horizontal equity is concerned with those who have equal needs and should therefore receive the same treatment, irrespective of other ‘non-need’ characteristics that ought not to affect use. Most of the work on horizontal equity explores the deviation of this principle with respect to income or some other socioeconomic factor. However, egalitarian equity goals also distinguish vertical equity in health care delivery, which has been given very little attention in the empirical literature. Vertical equity is defined as the appropriately different treatment of individuals with different needs. This requires making strong value judgements about the way consumption ought to vary amongst individuals with different levels of need, and therefore most empirical work considers only horizontal inequity in health care utilisation.

The aim of the PhD is to develop a methodology for the measurement of vertical equity in the delivery of health care and to apply this methodology to a number of analyses. This research will take forward this aim by providing:

  • A review of the methods previously used in the literature to measure vertical equity in the delivery of health care and in other fields; and to identify their limitations.
  • Consideration of new methodologies for the measurement of vertical equity in the delivery of health care.
  • The application of these methodologies to individual-level household survey data to test for and measure vertical equity in health care utilisation.
  • The application of these methodologies to area-level data to identify vertical equity in the allocation of resources geographically across areas.

For further information, contact Laura Vallejo-Torres (email: l.vallejo-torres@ucl.ac.uk; tel: 020 7679 1702)