Health care and economic well-being: estimating equivalence scales for public health care utilization

Inconsistency between the income concept and the needs associated with its use can yield seriously misleading welfare assessments in comparisons concerning different household types. Equivalence scales are typically estimated from expenditure data that make them compatible with welfare adjustments involving cash income. However, if the welfare analysis extends to economic benefits other than cash income, the equivalence scale must be adjusted to account for needs relevant to the particular form of benefit. This paper derives needs-based equivalence scales for public health care utilization. The scales are estimated from the health care utilization data of different services. In addition, redistributional analysis is used to investigate the effects of adopting various income concepts and allowing for health care needs in the equivalence scale. The results clearly reveal the conceptual importance of accounting for health status, household size and age in welfare comparisons concerning non-cash transfers. It is also shown that the redistributive effect of public health care is heavily dependent upon assumptions made about its scope.