Most OECD countries have endorsed as major policy objectives the reduction of inequalities in health status and the principle of adequate or equal access to health care based on need. It is important to monitor the extent to which these policy objectives are achieved on a regular basis.
Inequalities in access to care may exist along many demographic or social dimensions, including sex, age, racial and ethnic group, geographic area and socioeconomic status. While socioeconomic status can be defined in various ways, one of the most common definitions is by income level.
A 2004 OECD study (OECD Health Working Paper No 14 by Van Doorslaer and Masseria) found that while there was no significant inequality in the use of general practitioners (family doctors) among people in different income groups in most countries, high-income people were more likely to consult specialists than those with low incomes in nearly all countries. The same was also true for consultations with dentists.
Lower use of certain health services may result in poorer health status for the population affected.
Aims of the project
The main aim of this project was to update the previous (2004) OECD study by Van Doorslaer and Masseria and re-examine income-related inequalities in health service utilisation in 19 OECD countries up to 2008-2009: 13 of the countries in the new study were already included in the previous one while 6 new countries were added to the analysis. The analysis covered most of the services that were examined in the first study, such as doctor visits and dentist visits, but it also included inequalities in cancer screening rates as a good example of the take-up of a preventive intervention.
Comparing results of the two studies gives information on the evolution of inequalities in health care utilisation.
The study was based mainly on the most recent waves of national population-based health interview surveys in the 19 countries covered: Austria, Belgium, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, New Zealand, Poland, Slovak Republic, Slovenia, Spain, Switzerland, the United Kingdom and the United States.
The second aim of the study was to analyse some possible factors that might explain income-related inequalities in health care use. This analysis was based on selected characteristics of health systems, with a focus on how these health care services are financed in different countries. To do this, a number of other data collections were used, including the database OECD Health Statistics, and the 2008 OECD Survey on Health Systems Characteristics (Paris, Devaux and Wei, 2010).
Findings show that, for doctor visits, horizontal inequities in health care utilisation persist across OECD countries. After adjustment for needs for health care, the better-off are more likely to visit doctors, especially specialists. With GP contacts, the scenario is different. In most countries, for the same level of need for health care, the worse-off are as likely as the better-off to contact a GP, and they visit more often. Inequalities in dental visits and breast and cervical cancer screening appear in numerous countries, with the better-off making more use of services.
The relative position of countries has remained stable for doctor and GP visits over the two studies. Some discrepancies are found in country ranks for specialist and dentist visits, but these are attributed to methodological differences.
Findings highlight the important effect that the financing of health care services can have on equity (public and private health insurance coverage, and the share of out-of-pocket payments for different services), although some of the inequalities in health service use cannot be explained by financial barriers.
Marion Devaux: firstname.lastname@example.org
Permanent URL: http://www.oecd.org/health/inequalities