2009 Volume 21 Issue 2 Pages 99-113
Most empirical studies have neglected vertical equity in the distribution of health care services, focusing instead on horizontal equity. The present paper aims to investigate the relationships among the need for inpatient care, the amount of inpatient care services provided, and money transfers to Japanese municipal hospitals in the Kansai region from the viewpoint of vertical equity. The Standardized Mortality Ratio (SMR), which is a Bayes estimator, was used as an indicator of the need for inpatient care. Data from 89 municipal hospitals were collected from The Yearbook of Public Firms, Edition for Hospitals. Concentration index and Theil’s second measure were used to analyze the distribution of allotments to municipal hospitals.
The major findings can be summarized as follows. First, allotments per patient per day showed vertical equity in need for inpatient care, and inpatient cost per inpatient per day almost reached vertical equity throughout the Kansai region. However, allotments showed vertical inequity in the number of inpatients per day after taking into account the overall social welfare regarding the distribution of allotments. Second, inequality in allotment per inpatient was the largest with regard to allotment per patient per day. Inequality in the number of outpatients per physician increased in 2005 compared to previous years. This was caused by the movement of physicians following the introduction of a new in-service training system. Third, disparities in physician visits are underestimated when we do not take into account the flow of inpatients and overestimate the extent of inequality in allotments per patient per day.
