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Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006

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Abstract

Objective

The aim of this study was to analyse the trends and socio-economic inequalities in the use of health care services in Spain between 1993 and 2006.

Methods

A study of trends was performed using data from six Spanish National Health Surveys (1993, 1995, 1997, 2001, 2003 and 2006). Sample sizes were 21,061; 6,396; 6,396; 21,066; 21,650 and 29,478, respectively. The following dependent variables were analysed: having visited a general practitioner (GP) or specialist in the previous 2 weeks, having visited a dentist within the previous 3 months and having visited a gynaecologist, having used the emergency services or having been hospitalised in the previous year. The main independent variable was social class, classified as manual or non-manual occupation. For each service, age-standardised proportions of use were calculated by survey year, sex and social class, and indices of relative (RII) and absolute (SII) inequality were computed. Trend tests were applied.

Results

An increase in the proportion of use was observed for all services, particularly emergency services. Individuals from manual classes were more likely to visit the GP and emergency services than those from non-manual classes. Conversely, those from non-manual classes were more likely to use specialised services. This trend was most notable for dentist visits. Social inequalities did not change significantly during the study period.

Conclusions

Despite the increase in the use of health care services, the relationship between social class and the use of these services has remained stable throughout the study period. Achieving equity in the use of specialised care services is still a challenge for universal health care systems.

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Acknowledgments

This study was partially supported by the Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (I + D + I) of the Instituto de Salud Carlos III—Subdirección General de Evaluación y Fomento de la Investigación (PI07/90302) and by the program Intensificación de la Actividad Investigadora (granted to Carme Borrell) funded by the Instituto de Salud Carlos III and by the Departament de Salut, Generalitat de Catalunya.

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Authors and Affiliations

  1. CIBER de Epidemiología y Salut Pública (CIBERESP), Madrid, Spain

    Laia Palència, Albert Espelt, Maica Rodríguez-Sanz, M. Isabel Pasarín & Carme Borrell

  2. Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain

    Albert Espelt

  3. Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain

    Laia Palència, Albert Espelt, Maica Rodríguez-Sanz, Katia B. Rocha, M. Isabel Pasarín & Carme Borrell

  4. Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

    Laia Palència, Albert Espelt, Maica Rodríguez-Sanz, Katia B. Rocha, M. Isabel Pasarín & Carme Borrell

  5. Universitat Pompeu Fabra, Barcelona, Spain

    Laia Palència, M. Isabel Pasarín & Carme Borrell

Authors
  1. Laia Palència
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  2. Albert Espelt
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  3. Maica Rodríguez-Sanz
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  4. Katia B. Rocha
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  5. M. Isabel Pasarín
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  6. Carme Borrell
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Corresponding author

Correspondence to Laia Palència.

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Palència, L., Espelt, A., Rodríguez-Sanz, M. et al. Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006. Eur J Health Econ 14, 211–219 (2013). https://doi.org/10.1007/s10198-011-0362-7

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  • DOI: https://doi.org/10.1007/s10198-011-0362-7

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