Equity in health and health care in a decentralised context: evidence from Canada
利用加拿大2001年社区健康调查数据，分解集中指数，发现收入相关的健康不平等主要源于地区内部差异，而医疗使用的不公平则主要由省际差异驱动。
The impact of administrative decentralisation on equity in health and health care is an important unresolved issue in the health policy debate. Predictions from the limited theoretical literature and the relevant empirical research are both insufficient to draw any firm conclusions. Many countries are nevertheless experimenting with decentralisation policies in the absence of research evidence. This paper presents an exploratory empirical analysis of decentralisation by investigating the spatial dimensions of health-related equity in Canada, a highly decentralised setting. Using data from the 2001 Canadian Community Health Survey, we apply a decomposition method of the Concentration Index to explore whether income-related inequalities in health and inequities in the use of health care are more likely to be due to gaps between rich and poor Canadian provinces rather than to differences between rich and poor individuals within them. The results show that within area variation is the most important source of income-related health inequality, while income-related inequities in health care use are mostly driven by differences between provinces.