The European Journal of Health Economics

, Volume 14, Issue 2, pp 211–219 | Cite as

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

  • Laia PalènciaEmail author
  • Albert Espelt
  • Maica Rodríguez-Sanz
  • Katia B. Rocha
  • M. Isabel Pasarín
  • Carme Borrell
Original Paper



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.


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.


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.


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.


Health care use Inequalities Social class Trends National Health System 

JEL Classification

D63 I14 I18 



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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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Laia Palència
    • 1
    • 3
    • 4
    • 5
    Email author
  • Albert Espelt
    • 1
    • 3
    • 4
    • 2
  • Maica Rodríguez-Sanz
    • 1
    • 3
    • 4
  • Katia B. Rocha
    • 3
    • 4
  • M. Isabel Pasarín
    • 1
    • 3
    • 4
    • 5
  • Carme Borrell
    • 1
    • 3
    • 4
    • 5
  1. 1.CIBER de Epidemiología y Salut Pública (CIBERESP)MadridSpain
  2. 2.Departament de Psicobiologia i Metodologia de les Ciències de la SalutUniversitat Autònoma de BarcelonaBellaterra (Cerdanyola del Vallès)Spain
  3. 3.Agència de Salut Pública de BarcelonaBarcelonaSpain
  4. 4.Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)BarcelonaSpain
  5. 5.Universitat Pompeu FabraBarcelonaSpain

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