Income distribution, income change and health: on the importance of absolute and relative income for health status in Sweden.
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This article develops and evaluates a method for deriving postcensal estimates of household income distributions for counties. A modified lognormal probability curve is used as a model of income distribution. The function is closely related to the classical lognormal model, but it contains a nonlinear component in its derivation. Simulated postcensal estimates of household income distributions are compared with 1980 census data for the counties in California. The results indicate that the modified lognormal curve approximates observed income distributions well and produces reliable postcensal estimates for areas with a wide variety of median income levels and numbers of households.
This paper discusses physician income distribution within a group practice setting. In this discussion, factors affecting physician-income generation and distribution are explored, including objectives of incentive programs, overall economics of group practices, methods of distributing income which are most commonly employed, and other issues that affect incentive compensation.
In a series of papers published during the past decade Richard Wilkinson has advanced the view that income inequality is the key determinant of variations in average life expectancy at birth among developed countries. Yet a careful examination of the two sources of data on income distribution most often used by Wilkinson suggests that if they are analysed more appropriately they do not lend support to his claims. More recent data on income distribution is now available for several countries in the Organisation for Economic Development and Cooperation in the mid-1980s and for Great Britain from 1961 to 1991. The use of these data also casts doubt on the hypothesis that inequalities in the distribution of income are closely associated with variations in average life expectancy at birth among the richest nations of the world.
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Using data from the New Beneficiary Survey, this article examines income received by the newly retired from assets, employer-provided pensions, and social security. Today's retirees commonly possess pension or asset income to supplement social security. The proportions with asset income were 83 percent for married men and their wives and 69 percent for the unmarried. The proportions with pension income were 56 percent for the married couples and 42 percent for the unmarried. The article finds that up through the middle of the income distribution, social security remains the main income component. In addition to these traditional income sources of the retired, the data also highlight the important role of earnings among many of the new beneficiaries--44 percent of the married couples and 27 percent of the unmarried had current earnings.
The study measures the economic vulnerability of disabled persons whose impaired health interfered with their earning ability. This population segment, about one sixth of the total population, represents the extreme both in terms of sensitivity to health problems and losses in economic power. The major findings are given in a nutshell. 1) Inadequate income did not bar the disabled individuals from contact with the medical care system except in the case of the weakest among the weak, the aging women without husbands. This finding suggests that the restraining effect of income can become strong enough to overcome the concern with ill-health, although the inhibiting effect of economic constraints weakens when the concerns with health problems intensifies. (2) Once contact with the health care system had been extablished, there was no evidence to suggest that lack of means to pay for medical services had restricted the quantity of services rendered to the disabled, although inability to pay might have affected the setting in which care was provided. 3) The needed medical care was obtained at a considerable financial sacrifice. As Table 6 shows, the level of direct out-of-pocket payments imposed a heavy burden on low and moderate income households, and this burden eased gradually as household income-levels increased.
On average, persons receiving Social Security benefits tend to have lower current incomes than do persons paying Social Security taxes. This article documents OASDI's income distributional patterns by dividing the 1992 Current Population Survey population into 10 income deciles and tabulating benefits received and taxes paid by each decile. The benefits and taxes, when compared with non-Social Security income, are progressive: as income rises from decile to decile, the ratio of benefits to income falls, and, except at the highest deciles, the ratio of taxes to income rises. A large component of the current income distributional pattern is associated with age: the young on average receive more income and pay more taxes; the old on average receive more benefits. However, when benefits and taxes are tabulated for income deciles within specific age groups, a general progressivity is still observable, although it is weaker than that for the population as a whole.
The American family income distribution now lies at the center of several controversies. Some observers argue that the American middle class is vanishing, but U.S. census income statistics show income inequality has not changed appreciably since 1947. A second controversy involves whether average living standards have risen or fallen since the major oil price increase of 1973-74. These controversies can be partially resolved by understanding the sharp slowdown in the growth of workers' wages which occurred after 1973 and the demographic trends which kept per capita living standards rising despite stagnant wages, including more working women and low birthrates.
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Within a period of twenty years, America discovered that many of its citizens were hungry, acted to greatly reduce this problem through an array of federal programs, and, in the 1980s, learned that hunger has reappeared in epidemic proportions. The return of hunger to the U.S. is associated with economic and tax policies that have reallocated income distribution from poor and middle-income groups to the wealthy, and with a corresponding failure to utilize the federal government to protect high-risk population groups from undernutrition associated with growing economic deprivation in the nation.
A number of health policies have implications for, and in turn can be influenced by, the distribution of income. However, current discussions define the distribution in current, not lifetime, income. This study describes a method of estimating gender and race differences in the distribution of lifetime incomes that account for mortality differences. When cohort lifetime incomes of living and deceased persons are compared, black men are found to be much worse off, whereas white women are found to be better off than existing estimates using annual income suggest. The mortality and lifetime income advantage of white women, however, is offset if, as some argue, white women have higher morbidity rates than white men of the same age. The authors use the concept of lifetime income to draw implications for health policy debates on cigarette and beer taxes, occupational safety and health, Medicaid versus Medicare spending, educational health promotion programs, and general investments in education.
Social insurances effect income distributions between social strata. Here, insurance returns in relation to income are studied on the Swedish sickness allowance insurance, which is intended to redistribute from higher to lower social strata. Two measures of social class are used, the socio-economic classification, the official index of Sweden, and a structural class concept, which in earlier results discriminates better for material factors such as income and work conditions. The material consists of all sickness cases of 1983 for 3,161 persons, sampled from insurance registers and cross-classified with registers at taxation authorities. Data on insurance returns, incomes, and occupation are used. Results clearly confirm the intended redistribution effect, but considerably clearer with the structural class concept. The effect is even stronger than intended for some strata, where the system seems to lack in implementation. The consequences for choice of class measure are finally discussed.