1 Introduction
2 What are MDIs?
Guio (2009) | Guio et al. (2012) | Nolan and Whelan (2011) | Whelan and Maître (2012) |
---|---|---|---|
1. To pay their rent, mortgage or utility bills; 2. To keep home adequately warm; 3. To face unexpected expenses; 4. To eat meat or proteins regularly; 5. To go on holiday; 6. A television set; 7. A washing machine; 8. A car; 9. A telephone | 1. To pay their rent, mortgage or utility bills; 2. To keep home adequately warm; 3. To face unexpected expenses; 4. To eat meat or proteins regularly; 5. To go on holiday; 6. A car; 7. PC & internet 8. Replace worn-out furniture 9. Some new clothes 10. Two pairs of shoes 11. Some money for oneself 12. Leisure activities 13. Drink/meal monthly | 1. To pay their rent, mortgage or utility bills; 2. To keep their home adequately warm; 3. To face unexpected expenses; 4. To eat meat or proteins regularly; 5. To go on holiday; 6. A car; 7. PC | 1. To keep their home adequately warm; 2. To eat meat or proteins regularly; 3. Replace worn-out furniture 4. to go on holiday; 5. Some new clothes 6. Two pairs of shoes 7. Some money for oneself 8. Leisure activities 9. Drink/meal monthly |
Thresholds
| |||
3+: Material deprivation (MD) 4+: Severe material deprivation (SMD) | 5+: Material deprivation (MD) 7+: Severe material deprivation (SMD) | 2+: Material deprivation (MD) 3+: Severe material deprivation (SMD) | 2+: Material deprivation (MD) 3+: Severe material deprivation(SMD) |
Operationalization
| |||
Consensual criterion Expert criterion | Consensual criterion Expert criterion | Expert criterion | Expert criterion |
vis-à-vis income poverty measures
| |||
Union method Intersection method | Union method Intersection method | Intersection method | Intersection method |
Approach
| |||
Consensual approach Consistent poverty approach | Consensual approach Consistent poverty approach | Consistent poverty approach | Consistent poverty approach |
2.1 Possible Sources of Error for MDIs
3 Data and Methodology
3.1 Data
Variable | Survey question/Description | Scale | Recode |
---|---|---|---|
UHCNIR—unmet health care need due to inadequate resources | a. “Was there any time during the last twelve months when, in your opinion, you personally needed a medical examination or treatment for a health problem but you did not receive it?” b. (for those positively answer question a) what are the reasons for this unmet health care need?
derived using questions a and b—answering yes to the question a and stating “could not afford to” for the question b | a. 1: yes at least one case 0: no b. multiple categories from 1 to 8a
Binary—0/1 | |
Subjective health | “How is your general health?” | Interval 1 to 5 1: Very good 5: Very bad | Binary—1 if SH > 3 0 otherwise |
Disability | “For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? “ | Binary—0/1 | |
Chronic health problem | “Do you have any longstanding (6 months or more) illness or health problem?” | Binary—0/1 | |
Bad health |
derived—reporting bad subjective health or disability or chronic health problem | Binary—0/1 | |
SMD index (EU’s formal pov. measure) |
derived—9-item index of Guio (2009) | Binary—1 if SMD > 3; 0 otherwise | Interval—0 to 9 |
Relative income poverty (EU’s formal pov. measure) |
derived—Having equivalized household income below 60% of median household equivalized income | Binary—0/1 | |
Work intensity/joblessness (EU’s formal pov. measure) |
derived—Eurostat definition | Binary—0/1 | |
EU 2020 poverty headline indicator (at-risk-of-poverty and social exclusion) |
derived—Being identified as “poor” by SMD index or Income poverty or joblessness measures | Binary—0/1 | |
(Subj.) income inadequacy | “Thinking of your household’s total income, is your household able to make ends meet, namely, to pay for its usual necessary expenses?” | Interval 1 to 6 1: With great difficulty 3: With some difficulty 6: Very easily |
Binary form I:
1 if SII < 3 0 otherwise
Binary form II:
1 if SII < 4 0 otherwise |
3.2 An Alternative Methodological Approach to Test Empirical Validity of MDIs
Partial criterion variable (UHCNIR) | ||
---|---|---|
0 | 1 | |
Poverty measure (e.g. MDI) | ||
0 | a | b |
1 | c | d |
4 UHCNIR: A Solid Partial Criterion Variable for Poverty?
UHCNIR | EU2020 poverty indicator | |
---|---|---|
Gender | Female | Female |
Age group | 45–64, 65+ | 15–24, 45–64 |
Household type | Single person, Single parent, Extended family | Single person, Single parent, Extended family |
Marital status | Widowed, Divorced | Never married, Widowed, Divorced |
Place of residence | Thinly populated | Thinly populated |
Economic status | Unemployed, Retired, Disabled, Unpaid domestic worker, Other inactive | Unemployed, Student, Disabled, Domestic unpaid worker, Other inactive |
Occupation | Service workers, Skilled agr. and fishery worker, Craft trade workers, Elementary occupations | Service workers, Skilled agr. and fishery worker, Craft trade workers, Elementary occupations |
Health | Fair, bad, very bad reported health, Disability, Chronic health problems | Fair, bad, very bad reported health, Disability, Chronic health problems |
5 Results: Examining Empirical Validity of the MDIs
UHCNIR | ||||
---|---|---|---|---|
0 | 1 | |||
SMD index | 0 | 90.6% |
1.05%
| 91.7% |
1 | 7.36% | 0.99% | 8.34% | |
97.97% | 2.03% | 100% |
CONSENSUAL APPROACH Single MDI measures where indicators identified with a consensual method | |||
---|---|---|---|
MDIs | TIIE1
| TIIE2
| Headcount rate% |
Guio 2009—9 item | |||
3+ MD | 0.006 | 0.31 | 17.4 |
4+ SMD | 0.011 | 0.52 | 8.3 |
Guio et al. 2012—13 item | |||
5+ MD | 0.006 | 0.29 | 20.2 |
7+ SMD | 0.010 | 0.51 | 10.4 |
CONSISTENT POVERTY APPROACH MDIs combined with an income poverty measure (60% of national median equivalized household disposable income) | |||
---|---|---|---|
Guio 2009—9 item | |||
3+ MD | 0.014 | 0.67 | 6.6 |
4+ SMD | 0.015 | 0.75 | 3.8 |
Guio et al. 2012—13 item | |||
5+ MD | 0.014 | 0.68 | 7.2 |
7+ SMD | 0.015 | 0.76 | 4.3 |
Nolan and Whelan 2011—7 item | |||
2+ MD | 0.013 | 0.63 | 10.2 |
3+ SMD | 0.014 | 0.67 | 6.8 |
Whelan and Maître 2012—9 item | |||
2+ MD | 0.013 | 0.63 | 9.7 |
3+ SMD | 0.013 | 0.66 | 7.3 |
5.1 Relaxing the Assumption of Partial Criterion Variable
5.2 Sources of Error
5.3 Testing the Arguments
Odds ratio | 95% confidence interval | Test of homogeneity | |
---|---|---|---|
SMD index | |||
Healthy | 9.97 | 9.21–10.79 | Chi2(1) = 7.19 |
Unhealthy | 8.48 | 8.28–9.25 | Pr > Chi2 = 0.0073 |
Relative income poverty | |||
Healthy | 4.06 | 3.75–4.40 | Chi2(1) = 27.97 |
Unhealthy | 3.13 | 2.96–3.31 | Pr > Chi2 = 0.000 |
Income inadequacy | |||
Healthy | 18.5 | 14.78–23.45 | Chi2(1) = 0.11 |
Unhealthy | 17.6 | 14.95–20.86 | Pr > Chi2 = 0.74 |
Model 1 UHCNIR OR/se | Model 2 UHCNIR OR/se | Model 3 UHCNIR OR/se | Model 4 UHCNIR OR/se | Model 5 UHCNIR OR/se | Model 6 UHCNIR OR/se | |
---|---|---|---|---|---|---|
Guio’09 (SMD) | 9.26*** (.21) | 10.45*** (.401) | ||||
SMD*bad health | .836*** (.043) | |||||
Income poverty (IP) | 3.50*** (0.08) | 4.26*** (.165) | ||||
IP * bad health | .751*** (.038) | |||||
Income inadequacy (II) | 18.15*** | 19.08*** (2.18) | ||||
II * bad health | .925 (.13) | |||||
Bad health | 3.44*** (.09) | 3.74*** (.130) | 3.75*** (.10) | 4.18*** (.130) | 3.63*** (.10) | 3.91*** (.55) |
N | 349,438 | 349,438 | 349,438 | 349,438 | 349,438 | 349,438 |
Log likelihood | −33,063.9 | −33,057.3 | −35,872.2 | −35,855.5 | −34,709.6 | −34,709.4 |
Lrtest Chi2
| 13.34 | 33.97 | 0.30 | |||
Lrtest p
| 0.0003 | 0 | 0.58 |