Accounting for horizontal inequity in the delivery of health care: A framework for measurement and decomposition

Abstract The pursuit of equity is an objective of many healthcare systems. Horizontal equity, interpreted as “equal treatment for equal need”, has received much attention in both the policy and academia arenas. By combining the indirect standardization method with regression-based Shapley value decomposition, the paper aims to propose a framework for measuring and decomposing horizontal inequity and to investigate the contributors to horizontal inequity in health care delivery in China using the China Health and Nutrition Survey (CHNS) dataset. The horizontal inequity indicated by the Gini coefficient of indirectly standardized healthcare expenditure accounts for approximately 68.63 percent of the overall inequality, and the non-need factors, such as household registration, region, work status, education, income, insurance, and marital status, explain between 50 and 70 percent of the inequity, with household registration and region being the two largest contributors.