The European Journal of Health Economics

, Volume 15, Issue 3, pp 323–334 | Cite as

Equity in specialist waiting times by socioeconomic groups: evidence from Spain

  • Ignacio AbásoloEmail author
  • Miguel A. Negrín-Hernández
  • Jaime Pinilla
Original Paper


In countries with publicly financed health care systems, waiting time—rather than price—is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients’ socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients’ reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.


Equity Waiting times Specialist visits Hierarchical Bayesian models 

JEL Classification




This paper derives from a research project funded by the Spanish Ministry of Economy and Competitiveness (project ECO2012-36150). The authors are greatful to the Ministry for financial support. We are also grateful for comments on a first version of this paper to the participants at the Sheffield School of Health and Related Research Seminars, on the 30th July 2009. We are also thankful for comments of the two anonymous referees from EJHE. The usual disclaimers apply.


  1. 1.
    MSPSI: Ministerio de Sanidad, Política Social e Igualdad. Barómetro Sanitario. Informe Anual. Madrid (2011)Google Scholar
  2. 2.
    MSPSI: Ministerio de Sanidad, Política Social e Igualdad. Sistema de Información de Listas de Espera. Madrid (2011)Google Scholar
  3. 3.
    Van Doorslaer, E., Wagstaff, A., Van De Burg, H., et al.: Equity in the distribution of health care in Europe and the US. J. Health Econ. 19, 553–583 (2000)PubMedCrossRefGoogle Scholar
  4. 4.
    Abásolo, I., Manning, R., Jones, A.: Equity in utilisation of and access to public sector GPs in Spain. Appl. Econ. 33, 349–364 (2001)CrossRefGoogle Scholar
  5. 5.
    Van Doorslaer, E., Koolman, X., Jones, A.: Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 13, 629–647 (2004)PubMedCrossRefGoogle Scholar
  6. 6.
    Propper, C., Eachus, J., Chan, P., Pearson, N., Davey Smith, G.: Access to health care resources in the UK: the case of care for arthritis. Health Econ. 14, 391–406 (2005)PubMedCrossRefGoogle Scholar
  7. 7.
    Morris, S., Sutton, M., Gravelle, H.: Inequity and inequality in the use of health care in England: an empirical investigation. Soc. Sci. Med. 60(6), 1251–1266 (2005)PubMedCrossRefGoogle Scholar
  8. 8.
    Van Doorslaer, E., Masseira, C., Koolman, X.: Inequalities in access to medical care by income in developed countries. Can. Med. Assoc. J. 174(2), 177–183 (2006)CrossRefGoogle Scholar
  9. 9.
    Dixon, A., Le Grand, J., Henderson, J., Murray, R., Poteliakhoff, E.: Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization. J. Health Serv. Res. Policy 12, 104–109 (2007)PubMedCrossRefGoogle Scholar
  10. 10.
    Vallejo-Torres, L., Morris, S.: Income-related inequity in health care utilisation among individuals with cardiovascular disease in England—accounting for vertical inequity. Health Econ. 22(5), 533–553 (2013)PubMedCrossRefGoogle Scholar
  11. 11.
    Wagstaff, A., Van Doorslaer, E.: Equity in health care finance and delivery. In: Culyer, A.J., Newhouse, J.P. (eds.) Handbook of Health Economics. Elsevier, Amsterdam (2000)Google Scholar
  12. 12.
    Pell, J., Pell, A., Norrie, J., Ford, I., Cobbe, S.: Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. BMJ 320, 15–19 (2000)PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Fitzpatrick, R., Norquist, J., Reeves, B., et al.: Equity and need when waiting for total hip replacement surgery. J. Eval. Clin. Pract. 10(1), 3–9 (2004)PubMedCrossRefGoogle Scholar
  14. 14.
    Hacker, J., Stanistreet, D.: Equity in waiting times for two surgical specialties: a case study at a hospital in the North West of England. J. Public Health 26(1), 56–60 (2004)CrossRefGoogle Scholar
  15. 15.
    Arnesen, K., Eriksen, J., Stavem, K.: Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management. Health Policy 62(3), 329–341 (2002)PubMedCrossRefGoogle Scholar
  16. 16.
    Kee, F., Gaffney, B.: Priority for coronary artery surgery: who gets by-passed when demand outstrips capacity? Q. J. Med. 88(1), 15–22 (1995)Google Scholar
  17. 17.
    Löfvendahl, S., Eckerlund, I., Hansagi, H., Malmqvist, B., Resch, S., Hanning, M.: Int. J. Qual. Health Care 17(2), 133–140 (2005)PubMedCrossRefGoogle Scholar
  18. 18.
    Coyte, P., Wright, J., Gillian, M., et al.: Waiting times for knee-replacement surgery in the United States and Ontario. New Engl. J. Med. 331(16), 1068–1071 (1994)PubMedCrossRefGoogle Scholar
  19. 19.
    Kelly, K., Voaklander, D., Johnston, W., Suarez-Amador, M.: Equity in waiting times for major arthroplasty. Can. J. Surg. 45(4), 269–276 (2002)PubMedCentralPubMedGoogle Scholar
  20. 20.
    Shortt, S., Shaw, R.: Equity in Canadian health care: does socioeconomic status affect waiting times for elective surgery? Can. Med. Assoc. J. 168(4), 413–416 (2003)Google Scholar
  21. 21.
    Cooper, Z., McGuire, A., Jones, S., Le Grand, J., Titmuss, R.: Equity, waiting times and the NHS reforms: retrospective study. BMJ 339(b3264), 1–7 (2009)Google Scholar
  22. 22.
    Siciliani, L., Verzulli, R.: Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE. Health Econ. 18, 1295–1306 (2009)PubMedCrossRefGoogle Scholar
  23. 23.
    BOE: Boletín Oficial del Estado. Real Decreto 605 de 23 de Mayo: medidas para el tratamiento homogéneo de la información sobre las listas de espera en el Sistema Nacional de Salud, 134, 5 Junio (2003)Google Scholar
  24. 24.
    Congdon, P.: Applied Bayesian Hierarchical Methods. CRC Press/Chapman & Hall, Florida (2010)CrossRefGoogle Scholar
  25. 25.
    MSPSI: Ministerio de Sanidad, Política Social e Igualdad. Encuesta Nacional de Salud. Madrid (2006)Google Scholar
  26. 26.
    MacNab, Y.: Hierarchical Bayesian modeling of spatially correlated health service outcome and utilization rates. Biometrics 59(2), 305–316 (2003)PubMedCrossRefGoogle Scholar
  27. 27.
    Allenby, G., Rossi, P.: Hierarchical Bayes models: a practitioner’s guide. In: Grover, R., Vriens, M. (eds.) The Handbook of Marketing Research. Sage, New York (2006)Google Scholar
  28. 28.
    Ogle, K.: Hierarchical Bayesian statistics: merging experimental and modeling approaches in ecology. Ecol. Appl. 19, 577–581 (2009)PubMedCrossRefGoogle Scholar
  29. 29.
    Browne, W., Draper, D.: A comparison of Bayesian and likelihood-based methods for fitting multilevel models. Bayesian Anal. 3, 473–514 (2006)Google Scholar
  30. 30.
    Lambert, P.C., Sutton, A.J., Burton, P.R., Abrams, K.R., Jones, D.R.: How vague is vague? A simulation study of the impact of the use of vague prior distributions in MCMC using WinBUGS. Stat. Med. 24, 2401–2428 (2005)PubMedCrossRefGoogle Scholar
  31. 31.
    Browne, W., Goldstein, H.: An Introduction to Bayesian Multilevel Hierarchical Modelling using MLwiN; Centre for Multilevel Modelling, London (2002)Google Scholar
  32. 32.
    Greene, W.H.: Econometric Analysis, 6th edn. Prentice Hall, Upper Saddle River (2008)Google Scholar
  33. 33.
    Maddala, G.S., Lahiri, K.: Introduction to Econometrics, 4th edn. Willey, West Sussex (2009)Google Scholar
  34. 34.
    Wooldridge, J.: Econometric Analysis of Cross Section and Panel Data, 2nd edn. MIT Press, Cambridge (2010)Google Scholar
  35. 35.
    Williams, A.: Priority setting in public and private health care: a guide through the ideological jungle. J. Health Econ. 7, 173–183 (1988)PubMedCrossRefGoogle Scholar
  36. 36.
    Neal, R.D., Allgar, V.L.: Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the ‘National Survey of NHS Patients: Cancer’. Br. J. Cancer 92, 1971–1975 (2005)PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    O’Donnell, C.: Variation in GP referral rates: what can we learn from the literature? Family Pract. 17, 462–471 (2000)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ignacio Abásolo
    • 1
    Email author
  • Miguel A. Negrín-Hernández
    • 2
  • Jaime Pinilla
    • 2
  1. 1.Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Facultad de Ciencias Económicas y EmpresarialesUniversidad de La LagunaLa LagunaSpain
  2. 2.Departamento de Métodos Cuantitativos en Economía y GestiónUniversidad de Las Palmas de Gran CanariaLas Palmas de Gran CanariaSpain

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