Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries
- 2.8k Downloads
A key policy objective in OECD countries is to achieve adequate access to health care for all people on the basis of need. Previous studies have shown that there are inequities in health care services utilisation (HCSU) in the OECD area. In recent years, measures have been taken to enhance health care access. This paper re-examines income-related inequities in doctor visits among 18 selected OECD countries, updating previous results for 12 countries with 2006–2009 data, and including six new countries. Inequalities in preventive care services are also considered for the first time. The indirect standardisation procedure is used to estimate the need-adjusted HCSU and concentration indexes are derived to gauge inequalities and inequities. Overall, inequities in HCSU remain present in OECD countries. In most countries, for the same health care needs, people with higher incomes are more likely to consult a doctor than those with lower incomes. Pro-rich inequalities in dental visits and cancer screening uptake are also found in nearly all countries, although the magnitude of these varies among countries. These findings suggest that further monitoring of inequalities is essential in order to assess whether country policy objectives are achieved on a regular basis.
KeywordsInequality Inequity Doctor visit Preventive care Health care access
JEL ClassificationI10 I14
The author would like to thank Michael de Looper for his contribution at the initial stage of the work, and both anonymous reviewers for their helpful comments. The author also thanks data providers for supplying datasets, namely, Statistics Canada, the Finnish National Institute for Health and Welfare, the French Institute for Research and Information in Health Economics, the Robert Koch Institute for German data, the Irish Social Science Data Archive, the New Zealand Ministry of Health, the Spanish National Statistics Institute, the Swiss Federal Statistical Office, the Institute for Social and Economic Research for UK data, the American Agency for Healthcare Research and Quality, and Eurostat for EHIS. All data computations were prepared by the author, and the responsibility for the use and interpretation of these data is entirely that of the author.
- 1.Hurst, J., Jee-Hughes, M.: Performance measurement and performance management in OECD health systems. Labour Mark. Soc. Policy Series, Occasional Paper No 47, OECD, Paris. (2001). doi: 10.1787/788224073713
- 2.Kelley, E., Hurst, J.: Health care quality indicators project: conceptual framework paper. OECD Health Working Papers No.23. OECD Publishing, Paris. http://www.oecd.org/health/health-systems/36262363.pdf (2006). Accessed 22 June 2013
- 3.OECD: Health at a glance 2011: OECD indicators, OECD Publishing, Paris. (2011)Google Scholar
- 5.Van Doorslaer, E., Masseria, C.: Income-related inequality in the use of medical care in 21 OECD countries. OECD Health Working Paper No.14. OECD, Paris. http://www.oecd.org/health/health-systems/31743034.pdf (2004). Accessed 22 June 2013
- 6.Or, Z., Jusot, F., Yilmaz, E.: Impact of health care system on socioeconomic inequalities in doctor use. IRDES Working Paper No.17. IRDES, Paris. http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/DT17ImpactHealthCareSystSocioeconomicInequalities.pdf (2008). Accessed 22 June 2013
- 8.Palència, L., Espelt, S., Rodriguez-Sanz, M., Puigpinós, R., Pons-Vigués, M., Pasarín, M.I., Spadea, T., Kunst, A.E., Borrell, C.: Socioeconomic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int. J. Epidemiol. 39, 757–765 (2010)PubMedCrossRefGoogle Scholar
- 11.Carrieri, V., Wübker, A.: Assessing inequalities in preventive care use in Europe. Ruhr Economic Papers 371. http://www.rwi-essen.de/publikationen/ruhr-economic-papers/499/ (2012). Accessed 22 June 2013
- 12.ECHIM European Community health indicators monitoring. Accessed on 20 June 2013: www.echim.org
- 13.OECD Health Statistics. doi: 10.1787/health-data-en (2013). Accessed 05 October 2013
- 15.O’Donnell, O., van Doorslaer, E., Wagstaff, A., Lingelow, M.: Analyzing health equity using household survey data. The World Bank, Washington (2008)Google Scholar
- 19.Paris, V., Devaux, M., Wei, L.: Health Institutional Characteristics: A Survey of 29 OECD Countries, OECD Health Working Papers No. 50, OECD Publishing, Paris. doi: 10.1787/5kmfxfq9qbnr-en (2010). Accessed 22 Nov 2013
- 20.OECD: Cancer care: assuring quality to improve survival, OECD Publishing, Paris. doi: 10.1787/9789264181052-en (2013). Accessed 7 Dec 2013
- 22.Schopper, D., de Wolf, C: Breast cancer screening by mammography: international evidence and the situation in Switzerland, Krebsliga Schweiz. http://assets.krebsliga.ch/downloads/short_mammo_report_final_el_.pdf (2007). Accessed 22 June 2013
- 24.National Center for Health Statistics: Health, United States, 2010: with special feature on death and dying. NCHS, Hyattsville (2011)Google Scholar
- 25.Sirven, N., Or, Z.: Disparities in regular health care utilisation in Europe. IRDES Working Paper No. 37, IRDES, Paris. http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/DT37DisparitiesRegularHealthCareUtilisationEurope.pdf (2010). Accessed 22 June 2013
- 26.Von Wagner, C., Baio, G., Raine, R., Snowball, J., Morris, S., Atkin, W., Obichere, A., Handley, G., Rainbow, S., Smith, S., Halloran, S., Wardle, J.: Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int. J. Epidemiol. 40, 712–718 (2011)CrossRefGoogle Scholar
- 28.Devaux, M., de Looper, M.: Income-related inequalities in health service utilisation in 19 OECD Countries, 2008–2009, OECD Health Working Papers no. 58, OECD Publishing, Paris. 10.1787/5k95xd6stnxt-en (2012). Accessed 22 Nov 2013.
- 35.Tubeuf, S., Jusot F., Devaux M., Sermet C.: Social heterogeneity in self-reported health status and measurement of inequalities in health. IRDES Working Paper No. 12, IRDES, Paris. http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/DT12SocialHeterogeSelfReportHealthStatus.pdf (2008). Accessed 22 June 2013