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J Health Econ. 2004 Nov;23(6):1083-99.

Cut-point shift and index shift in self-reported health.

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Department of Economics, Tinbergen Institute Amsterdam, Free University of Amsterdam, De Boelelaan 1005, Amsterdam 1081 HV, The Netherlands.


There is some concern that ordered responses on health questions may differ across populations or even across subgroups of a population. This reporting heterogeneity may invalidate group comparisons and measures of health inequality. This paper proposes a test for differential reporting in ordered response models which enables to distinguish between cut-point shift and index shift. The method is illustrated using Canadian National Population Health Survey data. The McMaster Health Utility Index Mark 3 (HUI3) is used as a more objective health measure than the simple five-point scale of self-assessed health. We find clear evidence of index shifting and cut-point shifting for age and gender, but not for income, education or language.

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