Health in Context

Abstract

With multilevel analysis, we can model the relationship between the context in which people live or act and an outcome at the individual level. In this chapter we discuss the relationship between the context or macro level and the individual or micro level. Sociologists have developed ways of analysing these relationships that may help our understanding of MLA. At the micro level, it is important to have a theory of human behaviour that takes context into account. But what contexts are relevant? That depends on the research question, and the phenomenon we are studying. Keywords Multilevel analysis · Social production function theory · Health behaviour · Healthcare providers · Social context · League tables Multilevel analysis enables us to analyse individual-level outcomes in relation to independent variables at the same level and independent variables at a higher level. This higher level is what we usually call the context or the macro level. In this chapter we give a theoretical analysis of the relationships between individual-or micro-level outcomes and contexts. However, the relationship between macro and micro levels has two dimensions. Not only does the context, such as the availability of health services in an area, influence behaviour (e.g. health service utilisation), there is also an influence the other way around: from micro to macro level. Continuing this example, the health service utilisation of many individuals will result in a high level of healthcare expenditure in an area. Often we are interested in both directions. MLA is especially suited for analysis in one direction, from macro to micro level, and less so the other way around. However, when we are analysing 'league tables' of hospital performance at the end of this chapter, we can use MLA to arrive at estimates of hospital effects, taking differences in the composition of the patient populations (case-mix differences) into account. We start this chapter examining the relationship between macro-level context and individual, micro-level outcomes. The other dimension, from micro level to macro level, will be addressed at the end of this chapter. At that stage we will also briefly introduce league tables. In between we discuss theories about behaviour (the micro level) and the relevance of different contexts.