UNDERSTANDING DIFFERENT METHODOLOGICAL APPROACHES TO MEASURING INEQUITY IN HEALTH CARE

The objectives of this study were to classify different methodological approaches to measuring inequity in health care, identify the strengths and weaknesses of each approach, and suggest directions for future improvement of each approach. The authors classified three approaches to measuring inequity in health care according to: (1) collective expert judgments (clinical standard approach), (2) average health care use based on need (population standard approach), and (3) assessment of health care users or providers (direct approach). The clinical standard approach has strong face validity and immediate policy implication, while lacking global policy implications. The population standard approach offers a global picture of inequity but has weak face validity. The direct approach can reveal private information of health care users and offer opportunity for managing public expectation. Strengths and limitations of these approaches are complementary, suggesting directions for future improvements of each approach. This study will help researchers make a well-informed choice of measurement approach and assist policymakers in resolving some of the problems caused by the diverse findings of studies, partly due to the measurement approaches taken.