Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey
In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth.
The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression.
We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women.
In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.
- Exworthy, M, Blane, D, Marmot, M (2003) Tackling health inequalities in the United Kingdom: the progress and pitfalls of policy. Health Serv Res 38: pp. 1905-1922 CrossRef
- Hanratty, B, Zhang, TH, Whitehead, M (2007) How close have universal health systems come to achieving equity in use of curative services? A systematic review. Int J Health Serv 37: pp. 89-109 CrossRef
- Tudor Hart, J (1971) The inverse care law. Lancet 297: pp. 405-412 CrossRef
- van Doorslaer, E, Wagstaff, A, van der Burg, H, Christiansen, T, De Graeve, D, Duchesne, I, Gerdtham, UG, Gerfin, M, Geurts, J, Gross, L, Hakkinen, U, John, J, Klavus, J, Leu, RE, Nolan, B, O'Donnell, O, Propper, C, Puffer, F, Schellhorn, M, Sundberg, G, Winkelhake, O (2000) Equity in the delivery of health care in Europe and the US. J Health Econ 19: pp. 553-583 CrossRef
- van Doorslaer, E, Masseria, C (2004) Income-Related Inequality in the Use of Medical Care in 21 OECD Countries. CrossRef
- Grasdal, A, Monstad, K (2011) Inequity in the use of physician services in Norway before and after introducing patient lists in primary care. Int J Equity Health 10: pp. 25 CrossRef
- Iversen, T, Kopperud, GS (2005) Regulation versus practice - the impact of accessibility on the use of specialist health care in Norway. Health Econ 14: pp. 1231-1238 CrossRef
- Masseria, C, Giannoni, M (2010) Equity in access to health care in Italy: a disease-based approach. Eur J Public Health 20: pp. 504-510 CrossRef
- van Doorslaer, E, Masseria, C, Koolman, X (2006) Inequalities in access to medical care by income in developed countries. Can Med Assoc J 174: pp. 177-183 CrossRef
- Bago d'Uva, T, Jones, AM, van Doorslaer, E (2009) Measurement of horizontal inequity in health care utilisation using European panel data. J Health Econ 28: pp. 280-289 CrossRef
- Krokstad, S, Langhammer, A, Hveem, K, Holmen, T, Midthjell, K, Stene, T, Bratberg, G, Heggland, J, Holmen, J (2012) Cohort profile: the HUNT study, Norway. Int J Epidemiol.
- Holmen, J, Midthjell, K, Krüger, Ø, Langhammer, A, Holmen, TL, Ross, GB, Vatten, LJ, Lund-Larsen, PG (2003) The nord-trøndelag health study 1995–97 (HUNT 2): objectives, contents, methods and participation. Norsk Epidemiologi 13: pp. 19-32
- Skalicka, V, van Lenthe, F, Bambra, C, Krokstad, S, Mackenbach, J (2009) Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study. Int J Epidemiol 38: pp. 1272-1284 CrossRef
- Krokstad, S (2004) Socioeconomic inequalities in health and disability. Social epidemiologi in the Nord-Trøndelag Health Study (HUNT). Norwegian University of Science and Technology, Norway
- Krokstad, S, Westin, S (2002) Health inequalities by socioeconomic status among men in the nord-trondelag health study, Norway. Scand J Public Health 30: pp. 113-124
- Zou, G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159: pp. 702-706 CrossRef
- O'Donnell, O, van Doorslaer, E, Wagstaff, A, Lindelow, M (2008) Analyzing health equity using household survey data: a guide to techniques and their implementation. The World Bank, Washington, D.C.
- Gjelsvik, R, Holmås, T, Monstad, K (2009) Socio-economic differences in treatment intensity in GP practice. Health Economics Bergen Working Papers, Bergen, Norway
- Krokstad, S, Westin, S (2004) Disability in society-medical and non-medical determinants for disability pension in a Norwegian total county population study. Soc Sci Med 58: pp. 1837-1848 CrossRef
- Bago d'Uva, T, Lindeboom, M, O'Donnell, O, van Doorslaer, E (2011) Education-related inequity in healthcare with heterogeneous reporting of health. J R Stat Soc A Stat Soc 174: pp. 639-664 CrossRef
- van Doorslaer, E, Koolman, X, Jones, AM (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 13: pp. 629-647 CrossRef
- Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
International Journal for Equity in Health
- Online Date
- August 2012
- Online ISSN
- BioMed Central
- Additional Links
- Social inequalities
- Health care
- Health services research
- Public health
- Author Affiliations
- 1. Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), MTFS, 7489, Trondheim, Norway
- 2. HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 3. Levanger Hospital, Nord-Trøndelag Health Authority, Trondheim, Norway