Multilevel modeling of regional variation in equity in health care.

Medical Care
Sonja LummeIlmo Keskimäki

Abstract

The use of a concentration index is recommended to estimate socioeconomic equity in health and health services. Methods for the analysis of concentration indices have been developed in several studies. However, these methods do not take into consideration clustering within areas, which is necessary in a comprehensive study of regional variations in equity. The study aims to develop a statistical method to assess variations in socioeconomic inequities in the use of health services in relation to need in different regions. Concentration index methods were developed further and the advantages of multilevel modeling were exploited. As an empirical example we analyzed revascularizations in 2001-2003 among the Finnish population. The average inequity indices for the income distribution of revascularizations in Finland obtained with multilevel and standard regression modeling were comparable, but confidence intervals were smaller with multilevel modeling. Inequity indices for different areas estimated using multilevel modeling were more conservative and had smaller confidence intervals than indices estimated using the standard approach. The proposed approach is an efficient way of estimating regional variations in the socioeconomic eq...Continue Reading

References

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Citations

Sep 26, 2014·BMC Health Services Research·Kristiina ManderbackaIlmo Keskimäki
Jun 1, 2012·Social Science & Medicine·Sonja LummeIlmo Keskimäki
May 11, 2015·European Journal of Public Health·Kristiina ManderbackaIlmo Keskimäki
Aug 13, 2015·Journal of Preventive Medicine and Public Health = Yebang Ŭihakhoe Chi·Cheol-Sin KimChul-Woung Kim
Apr 15, 2010·Disaster Medicine and Public Health Preparedness·Jennifer R DavisErik R Svendsen
Sep 23, 2019·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Mohammad Habibullah PulokJane Hall

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