[EQ] Inequalities in access to medical care by income in developed countries

Inequalities in access to medical care by income in developed countries

Eddy van Doorslaer, Cristina Masseria, Xander Koolman for the OECD Health
Equity Research Group
>From the Department of Health Policy and Management, Erasmus University
Medical Centre, Rotterdam, Netherlands and the London School of Economics,
London, UK
CMAJ Canadian Medical Journal -• 2006; 174 (2). doi:10.1503/cmaj.050584.

Available online at: http://tinyurl.com/gefvb

Background: Most of the member countries of the Organization for Economic
Cooperation and Development (OECD) aim to ensure equitable access to health
care. This is often interpreted as requiring that care be available on the
basis of need and not willingness or ability to pay. We sought to examine
equity in physician utilization in 21 OECD countries for the year 2000.

Methods: Using data from national surveys or from the European Community
Household Panel, we extracted the number of visits to a general practitioner
or medical specialist over the previous 12 months. Visits were standardized
for need differences using age, sex and reported health levels as proxies.
We measured inequity in doctor utilization by income using concentration
indices of the need-standardized use.

Results: We found inequity in physician utilization favouring patients who
are better off in about half of the OECD countries studied. The degree of
pro-rich inequity in doctor use is highest in the United States and Mexico,
followed by Finland, Portugal and Sweden. In most countries, we found no
evidence of inequity in the distribution of general practitioner visits
across income groups, and where it does occur, it often indicates a pro-poor
distribution. However, in all countries for which data are available, after
controlling for need differences, people with higher incomes are
significantly more likely to see a specialist than people with lower incomes
and, in most countries, also more frequently. Pro-rich inequity is
especially large in Portugal, Finland and Ireland.

Interpretation: Although in most OECD countries general practitioner care is
distributed fairly equally and is often even pro-poor, the very pro-rich
distribution of specialist care tends to make total doctor utilization
somewhat pro-rich. This phenomenon appears to be universal, but it is
reinforced when private insurance or private care options are offered.

Other members of the OECD Health Equity Research Group: Gaetan Lafortune
(Health Policy Unit, OECD, Paris); Philip Clarke (Health Economics Research
Centre, University of Oxford and Economics Research School of Social
Sciences, Australian National University); Ulf-G Gerdtham (Department of
Community Medicine, Lund University, Sweden), Unto Häkkinen (Centre for
Health Economics, STAKES, Helsinki, Finland); Agnès Couffinhal and Sandy
Tubeuf (IRDES, France); Martin Schellhorn (IZA, Bonn, Germany); Agota Szende
(MEDTAP, UK); Gustavo Nigenda (FUNSALUD, Mexico); Astrid Grasdal (Health
Economics Department, University of Bergen, Norway); Robert E. Leu
(Department of Economics, University of Bern, Switzerland); Frank Puffer and
Elizabeth Seidler (Department of Economics, Clark University, Worcester, US)

Online at:
http://www.cmaj.ca/cgi/content/full/174/2/177?maxtoshow=&HITS=10&hits=10&RES
ULTFORMAT=&fulltext=doorslaer&andorexactfulltext=and&searchid=1&FIRSTINDEX=0
&sortspec=relevance&resourcetype=HWCIT

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Received on Mon Oct 2 09:08:24 2006