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

Maarten Lindeboom, Eddy Van Doorslaer

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219 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1083-1099
Number of pages17
JournalJournal of Health Economics
Issue number6
Publication statusPublished - Nov 2004
Externally publishedYes


  • Canada
  • Cut-point shift
  • D30
  • D31
  • Health measurement
  • Hierarchical ordered probit
  • I10
  • I12
  • Index shift

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