One of the more important debates in health economics at present is over the so-called “income gradient” in children’s health, and whether it’s flatter in the UK than in the US. I don’t have a dog in this fight, but the question of whether universal healthcare helps reduce rich-poor gaps in health outcomes is certainly a critical one. Here are the two papers, both of which have recently appeared in the Journal of Health Economics.
Is the Child Health / Family Income Gradient Universal? Evidence from England
Alison Currie, Stephen Wheatley Price & Michael Shields
In an influential study Case et al. (2002) documented a positive relationship between family income and child health in the US, with the slope of the gradient being larger for older than younger children. In this paper we explore the child health income gradient in England, which has a comprehensive publicly-funded National Health Service (NHS) founded on the twin principles of health care being free at the point of delivery and equality of access for the whole population. Our analysis is based on a sample of over 13,000 children (and their parents) drawn from the Health Survey for England. In accordance with Case et al. (2002), we find consistent and robust evidence of a significant family income gradient in child health using the subjective general health status measure. However, in England the size of the gradient is considerably smaller than that found for the US and we find no evidence that its slope increases with child age. We also provide new evidence that nutrition and family lifestyle choices have an important role in determining child health and that child health outcomes are highly correlated within the family. In addition, we find no evidence of an income gradient for objective indicators of child health, derived from nurse measurements and blood test results. Together our evidence is consistent with the hypothesis that the NHS has a protective effect on the health of children in England.
The Income Gradient in Children’s Health: A Comment on Currie, Shields and Wheatley Price
Anne Case, Diana Lee & Christina Paxson
This paper reexamines differences found between income gradients in American and English children’s health, in results originally published by Case, Lubotsky and Paxson (2002) for the US, and by Currie, Shields and Wheatley Price (2007) for England. We find that, when the English sample is expanded by adding three years of data, and is compared to American data from the same time period, the income gradient in children’s health increases with age by the same amount in the two countries. In addition, we find that Currie, Shields and Wheatley Price’s measures of chronic conditions from the Health Survey of England were incorrectly coded. Using correctly coded data, we find that the effects of chronic conditions on health status are larger in the English sample than in the American sample, and that income plays a larger role in buffering children’s health from the effects of chronic conditions in England. We find no ! evidence that the British National Health Service, with its focus on free services and equal access, prevents the association between health and income from becoming more pronounced as children grow older.