How Self-Rated is Self-Rated Health? Exploring the Role of Individual and Institutional Factors in Reporting Heterogeneity in Russia

In recent years the literature exploring the state dependent nature of individual self-rated health has grown rapidly. We contribute to this 'reporting heterogeneity' research field in two main ways. First, we are among the few studies to examine the determinants of reporting heterogeneity in self-rated health in the Russian context. Second, echoing the social determinants of health literature, we augment the standard battery of individual level socioeconomic and demographic characteristics with aggregated macro level variables serving as proxies for local environmental and social conditions. We are not aware of other heterogeneity studies that have incorporated this approach. Estimating a generalized ordered probit model we resolve the identification problem through the inclusion of an objective disease index. In terms of reporting heterogeneity, we find that response behaviour is systematically influenced by individual characteristics but also by aggregate regional socioeconomic characteristics. In particular, the finding that an individual's relative standing in their local economy can condition their response to subjective health questionnaires is important and merits further examination. We argue that both a relative income mechanism and a mechanism that links the cognitive process of choice with the sense of optimism that individuals have for their institutional environment are plausible explanations for the observed aggregate level effects.