| Literature DB >> 34414631 |
Sebastian Neumann-Böhme1, Arthur E Attema1, Werner B F Brouwer1, Job N J A van Exel1,2.
Abstract
In the evaluation of well-being, it is not only important what people have in absolute terms, but also how this compares to reference points in relative terms. We explore the relevance of relative comparisons by testing the effect of people's self-rated position on potential reference points for income and health on their subjective well-being. We used Multiple Discrepancies Theory as a framework to identify seven potentially relevant reference points for income and health. A representative sample (N = 550) of the Netherlands assessed their income and health relative to these reference points. In addition, we elicited monthly household income, health status (EQ-5D-5L), and subjective well-being (SWLS). In line with the literature, we found a negative convex relationship between subjective well-being and age and a positive relationship with being employed, income, and health. For income, subjective well-being was also associated with how current income compared to respondents' needs and progression over time, and for health especially with how current health compared to what they felt they deserved. Our findings suggest that income and health are important for subjective well-being both in absolute and relative terms. We found negative effects on life satisfaction if some of the domain specific reference points were not met.Entities:
Keywords: health; income; multiple discrepancy theory; reference points; subjective well-being
Mesh:
Year: 2021 PMID: 34414631 PMCID: PMC9291216 DOI: 10.1002/hec.4412
Source DB: PubMed Journal: Health Econ ISSN: 1057-9230 Impact factor: 2.395
Distribution of relative income categories and corresponding subjective well‐being (SWLS) values
| Variable | SWLS Compact | ||||
|---|---|---|---|---|---|
| Obsv. | Mean | sd | Min | Max | |
| A: Has income below their own subsistence level | 214 | 20.97 | 7.33 | 5 | 35 |
| B: Has income at subsistence level (below luxury level) | 108 | 24.26 | 5.67 | 8 | 35 |
| C: Has income in‐between subsistence and luxury level | 112 | 26.14 | 5.53 | 9 | 35 |
| D: Has income at luxury level (above subsistence level) | 82 | 27.51 | 5.42 | 10 | 35 |
| E: Has income at both subsistence and luxury level (all 3 values are the same) | 34 | 24.15 | 7.64 | 5 | 35 |
| Sum | 550 | 23.84 | 6.89 | 5 | 35 |
Descriptive summary statistics of demographic and health characteristics of the sample
| Variable | Level | Sample Statistic |
|---|---|---|
| Age (S.E., range) | 45.6 (0.64, 18–75) | |
| Gender (% male) | 49.3 | |
| Education | Low | 28.6 |
| Medium | 41.6 | |
| High | 29.8 | |
| Employment status | Employed | 48.1 |
| Unemployed | 11.8 | |
| Other | 40.1 | |
| Household income | Low (<1500 €) | 33.8 |
| Middle (1500 € ‐ 3999 €) | 59.5 | |
| High (>3999 €) | 6.7 | |
| Marital status | Married or living together | 59.1 |
| Other | 40.9 | |
| Children | Yes | 57.5 |
| No | 42.5 | |
| Health | EQVAS (S.E., range) | 76.8 (0.76, 9–100) |
| Mobility problems | 28.0 | |
| Self‐care problems | 7.5 | |
| Usual activities problems | 30.0 | |
| Pain/discomfort problems | 56.9 | |
| Anxiety/depression problems | 27.6 | |
| Cognitive functioning problems | 22.4 |
Descriptive statistics of the MDT domains
| Reference Points | Mean | S.E. and Range | Mean | S.E. and Range |
|---|---|---|---|---|
| Income domain | Health domain | |||
| Self‐needs | 5.9 | (0.09, 1–9) | 6.6 | (0.07, 1–9) |
| Self‐deserves | 5.6 | (0.09, 1–9) | 6.4 | (0.07, 1–9) |
| Self‐wants | 5.4 | (0.09, 1–9) | 6.7 | (0.08, 1–9) |
| Self‐others | 5.5 | (0.08, 1–9) | 6.4 | (0.07, 1–9) |
| Self‐past | 5.7 | (0.09, 1–9) | 6.5 | (0.09, 1–9) |
| Self‐progress | 5.4 | (0.09, 1–9) | 6.3 | (0.08, 1–9) |
| Self‐future | 5.5 | (0.09, 1–9) | 6.5 | (0.08, 1–9) |
FIGURE 1Distribution of responses in the multiple discrepancies theory Domains for income
FIGURE 2Distribution of responses in the multiple discrepancies theory Domains for health
Distribution of MDT reference points for income and health and corresponding subjective well‐being (SWLS) values using independent sample t‐tests
| SWLS Compact for Income | SWLS Compact for Health | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| MDT Domain | Level | Obs. | Mean | sd |
| Obs. | Mean | sd |
|
| Self‐need | Neutral or above | 436 | 25.47 | 5.75 | 0.0000 | 509 | 25.42 | 6.33 | 0.0000 |
| Below neutral | 114 | 17.62 | 7.36 | 41 | 15.44 | 7.95 | |||
| Self‐deserve | Neutral or above | 414 | 25.33 | 5.98 | 0.0000 | 494 | 24.82 | 6.17 | 0.0000 |
| Below neutral | 136 | 19.32 | 7.50 | 56 | 15.20 | 6.89 | |||
| Self‐want | Neutral or above | 384 | 25.59 | 5.93 | 0.0000 | 477 | 24.70 | 6.35 | 0.0000 |
| Below neutral | 166 | 19.79 | 7.27 | 73 | 18.21 | 7.65 | |||
| Self‐others | Neutral or above | 450 | 19.9 | 7.60 | 0.0000 | 498 | 24.44 | 6.52 | 0.0000 |
| Below neutral | 100 | 24.72 | 6.41 | 52 | 18.12 | 7.72 | |||
| Self‐past | Neutral or above | 419 | 25.26 | 6.23 | 0.0000 | 467 | 24.78 | 6.34 | 0.0000 |
| Below neutral | 131 | 19.29 | 6.94 | 83 | 18.53 | 7.49 | |||
| Self‐progress | Neutral or above | 406 | 25.56 | 5.98 | 0.0000 | 476 | 24.80 | 6.34 | 0.0000 |
| Below neutral | 144 | 19.00 | 7.00 | 74 | 17.69 | 7.17 | |||
| Self‐future | Neutral or above | 421 | 25.23 | 6.07 | 0.0000 | 486 | 24.83 | 6.34 | 0.0000 |
| Below neutral | 129 | 19.31 | 7.47 | 64 | 16.33 | 6.27 | |||
OLS regression of SWLS on respondent characteristics, health, and MDT for monetary and health questions
| SWLS | Model I | Model II | Model III | Model IV | Model V | Model VI | Model VII | Model VIII |
|---|---|---|---|---|---|---|---|---|
| Age | −0.27** | −0.25** | −0.26** | −0.19* | −0.18* | −0.30*** | −0.29*** | −0.23** |
| Age2 | 0.0031*** | 0.0029** | 0.0031*** | 0.0023** | 0.0022** | 0.0034*** | 0.0032*** | 0.0026** |
| Male (base: female) | −0.80 | −1.06** | −0.76 | −0.91* | −1.06** | −0.22 | −0.51 | −0.66 |
| Education level (base: low) | ||||||||
| Middle | 0.78 | 0.54 | 0.82 | 1.12* | 0.96* | 0.60 | 0.39 | 0.74 |
| High | 0.85 | 0.54 | 0.79 | 1.37** | 1.14* | 0.72 | 0.44 | 0.90 |
| Unemployed (base: working/training/retired) | −3.10**** | −3.13**** | −3.15**** | −1.68** | −1.78** | −2.97**** | −2.99**** | −1.93** |
| Married or living together (base: single, divorced, widow, other) | 1.09* | 1.13* | 1.04 | 0.79 | 0.82 | 0.97* | 1.01* | 0.79 |
| Has at least one child (base: no children) | 0.64 | 0.92 | 0.61 | 0.75 | 0.93 | 0.76 | 1.01* | 1.03* |
| Income (base: low <1500) | ||||||||
| Middle income (1500‐4000) | 1.09* | 0.11 | 1.23 | 0.049 | −0.47 | 1.08* | 0.20 | −0.30 |
| High income (>4000) | 3.69**** | 1.53 | 3.85*** | 2.17** | 0.83 | 3.08*** | 1.19 | 0.75 |
| Relative income (base: income below or at subs. Level) | ||||||||
| Income between subs. & luxury level | 2.20**** | 1.19** | 2.02**** | 1.26** | ||||
| Income at or above luxury level | 3.38**** | 2.32*** | 3.00**** | 2.26*** | ||||
| Income < basic needs budget | 0.20 | |||||||
| Health problem index | −1.85**** | −1.73**** | −1.89**** | −1.47**** | −1.43**** | −1.40**** | −1.30**** | −1.21**** |
| Health problem index^2 | 0.039** | 0.035** | 0.040** | 0.030** | 0.029* | 0.034*** | 0.030** | 0.027** |
| MDT reference points for income (base: better than neutral) | ||||||||
| Self‐need | −2.95**** | −2.80*** | −2.31*** | |||||
| Self‐deserve | −0.91 | −0.82 | −0.46 | |||||
| Self‐want | −0.79 | −0.69 | −0.68 | |||||
| Self‐others | 0.24 | 0.27 | 0.11 | |||||
| Self‐past | −0.82 | −0.91 | −0.74 | |||||
| Self‐progress | −2.29*** | −2.23*** | −1.97** | |||||
| Self‐future | 0.51 | 0.66 | 0.79 | |||||
| MDT reference points for health (base: better than neutral) | ||||||||
| Self‐need | −2.20 | −2.11 | −1.77 | |||||
| Self‐deserve | −3.62**** | −3.43**** | −2.27** | |||||
| Self‐want | 1.29 | 0.99 | 1.60 | |||||
| Self‐others | −1.42 | −1.50 | −1.51* | |||||
| Self‐past | −0.71 | −0.41 | −0.36 | |||||
| Self‐progress | −1.87* | −1.69* | −1.22 | |||||
| Self‐future | −1.44 | −1.58 | −1.39 | |||||
| R‐squared | 0.334 | 0.361 | 0.335 | 0.439 | 0.450 | 0.412 | 0.434 | 0.486 |
****p < 0.001.
***p < 0.01.
**p < 0.05.
*p < 0.10.
Robust standard errors for all models in parentheses
| SWLS | SE MI | SE M II | SE M III | SE M IV | SE M V | SE M VI | SE M VII | SE M VIII |
|---|---|---|---|---|---|---|---|---|
| Age | (0.11) | (0.11) | (0.11) | (0.099) | (0.098) | (0.10) | (0.100) | (0.096) |
| Age2 | (0.0012) | (0.0011) | (0.0012) | (0.0011) | (0.0011) | (0.0011) | (0.0011) | (0.0010) |
| Male (base: female) | (0.50) | (0.50) | (0.51) | (0.47) | (0.46) | (0.49) | (0.48) | (0.46) |
| Education level (base: low) | ||||||||
| Middle | (0.64) | (0.63) | (0.64) | (0.58) | (0.58) | (0.59) | (0.59) | (0.56) |
| High | (0.68) | (0.68) | (0.69) | (0.63) | (0.64) | (0.66) | (0.65) | (0.62) |
| Unemployed (base: working/training/retired) | (0.88) | (0.87) | (0.91) | (0.77) | (0.77) | (0.84) | (0.84) | (0.79) |
| Married or living together (base: single, divorced, widow, other) | (0.64) | (0.63) | (0.66) | (0.62) | (0.62) | (0.58) | (0.58) | (0.58) |
| Has at least one child | (0.65) | (0.63) | (0.66) | (0.60) | (0.59) | (0.61) | (0.60) | (0.58) |
| Income (base: low <1500) | ||||||||
| Middle income (1500‐4000) | (0.62) | (0.63) | (0.98) | (0.60) | (0.60) | (0.58) | (0.59) | (0.59) |
| High income (>4000) | (1.08) | (1.13) | (1.37) | (1.01) | (1.05) | (1.01) | (1.04) | (1.00) |
| Relative income (base: income below or at subs. Level) | ||||||||
| Income between subs. & luxury level | (0.59) | (0.57) | (0.57) | (0.57) | ||||
| Income at or above luxury level | (0.72) | (0.71) | (0.68) | (0.68) | ||||
| Income < basic needs budget | (1.01) | |||||||
| Health problem index | (0.39) | (0.39) | (0.39) | (0.36) | (0.37) | (0.33) | (0.33) | (0.33) |
| Health problem index^2 | (0.016) | (0.016) | (0.016) | (0.015) | (0.015) | (0.013) | (0.013) | (0.013) |
| MDT reference points for income (base: better than neutral) | ||||||||
| Self‐need | (0.88) | (0.87) | (0.89) | |||||
| Self‐deserve | (0.87) | (0.86) | (0.84) | |||||
| Self‐want | (0.72) | (0.72) | (0.72) | |||||
| Self‐others | (0.81) | (0.81) | (0.78) | |||||
| Self‐past | (0.72) | (0.70) | (0.69) | |||||
| Self‐progress | (0.80) | (0.79) | (0.80) | |||||
| Self‐future | (0.79) | (0.78) | (0.81) | |||||
| MDT reference points for health (base: better than neutral) | ||||||||
| Self‐need | (1.35) | (1.30) | (1.22) | |||||
| Self‐deserve | (0.98) | (0.95) | (0.93) | |||||
| Self‐want | (1.04) | (1.03) | (1.03) | |||||
| Self‐others | (0.96) | (0.95) | (0.90) | |||||
| Self‐past | (1.05) | (1.05) | (1.04) | |||||
| Self‐progress | (1.04) | (1.01) | (1.00) | |||||
| Self‐future | (1.06) | (1.02) | (0.98) | |||||