European Journal of Ageing

, Volume 9, Issue 1, pp 15–25 | Cite as

Variations in preventive care utilisation in Europe

  • Florence Jusot
  • Zeynep OrEmail author
  • Nicolas Sirven
Original Investigation


Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation both within and across European countries. In all countries, controlling for individual health status and country-level systemic differences, higher educated and higher income groups use more preventive services. At the health system level, high public health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services, including cancer screening, are higher.


Prevention Health systems Multilevel modelling SHARE BHPS 



This article uses data from SHARE release 2.3.0, as of November 13th 2009. SHARE data collection in 2004-2007 was primarily funded by the European Commission through its 5th and 6th framework programmes (project numbers QLK6-CT-2001- 00360; RII-CT-2006-062193; CIT5-CT-2005-028857). Additional funding by the US National Institute on Aging (grant numbers U01 AG09740-13S2; P01 AG005842; P01 AG08291; P30 AG12815; Y1-AG-4553-01; OGHA 04-064; R21 AG025169) as well as by various national sources is gratefully acknowledged (see for a full list of funding institutions). This article also uses data from the BHPS study which is funded by the Economic and Social Research Council (ESRC). The data was originally collected by the ESRC Research Centre on Micro-Social Change at the University of Essex. Over time, additional funding for the British Household Panel Survey (BHPS) has been provided by the Health Education Authority (HEA), Office for National Statistics (ONS) and Eurostat. The Northern Ireland sample, included from Wave 11, is jointly funded by the Economic and Social Research Council (ESRC) and various Northern Ireland government departments. Our research benefited from the jointed financial support of the French Institute for Health Promotion and Health Education (INPES), the National Authority for Health (HAS), the National Institute for Health and Medical Research (INSERM), the National Health Insurance Fund for Self-employed (RSI) as part of the research program “Prevention” supported by the French Institute for Public Health Research (IRESP) in 2007.


  1. Bago d’Uva T, Jones AM (2009) Health care utilisation in Europe: new evidence from the ECHP. J Health Econ 28:265–279CrossRefGoogle Scholar
  2. Blank PR, Szucs TD (2009) Vaccination coverage rates in eleven European countries during two consecutive influenza seasons. J Infect 58(6):446–458CrossRefGoogle Scholar
  3. Borella L (2008) Les pays européens face au cancer: étude d’un ensemble restreint d’indicateurs de santé publique. Bull Cancer 95(11):1053–1062Google Scholar
  4. Börsch-Supan, A, Jürges H (eds) (2005) The survey of health, ageing and retirement in Europe—methodology. Mannheim: Mannheim Research Institute for the Economics of Aging (MEA)Google Scholar
  5. Duport N, Ancelle-Park R (2006) Do socio-demographic factors influence mammography use of French women? Analysis of a French cross-sectional survey. Eur J Cancer Prev 15(3):219–224CrossRefGoogle Scholar
  6. European Commission (2006) European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, 4th edn. LuxembourgGoogle Scholar
  7. European Commission (2008) European Guidelines for Quality Assurance in Cervical Cancer Screening, 2nd edn. LuxembourgGoogle Scholar
  8. European Union (2003) Council Recommendation of 2 December 2003 on cancer screening (2003/879/EC). Official Journal of the European Union, L327, vol 46, 16 December 2003, 34–38Google Scholar
  9. Gosden T, Pedersen L, Torgerson D (1999) How should we pay doctors? A systematic review of salary payments and their effect on doctor behaviour. Q J Med 92:47–55CrossRefGoogle Scholar
  10. Gosden T, Forland F, Kristiansen IS, et al (2000) Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev 3, CD002215Google Scholar
  11. Kenkel DS (2000) Prevention. In: Culyer AJ, Newhouse JP (eds) Handbook of health economics, 1st edn, vol 1, chapter 3. Elsevier, pp 1675–1720Google Scholar
  12. Leyland AH, Goldstein H (eds) (2001) Multilevel modelling of health statistics. Wiley, New YorkGoogle Scholar
  13. Lorant V, Boland B, Humblet P, Deliège D (2002) Equity in prevention and health care. J Epidemiol Community Health 56:510–516CrossRefGoogle Scholar
  14. Mitchell J, Gaskin D (2007) Caregivers’ rating of access: do children with special health care needs fare better under fee-for-service or partially capitated managed care? Med Care 45:146–153CrossRefGoogle Scholar
  15. OECD (1994) Health care reform controlling spending and increasing efficiency. Economics Department Working Papers, 149, ParisGoogle Scholar
  16. OECD (2009) Health at a glance 2009: OECD indicators. OECD Publishing, ParisGoogle Scholar
  17. OECD (2010a) Health at a glance: Europe 2010. OECD Publishing, ParisGoogle Scholar
  18. OECD (2010b) Value for money in health spending, OECD health policy studies. OECD Publishing, ParisCrossRefGoogle Scholar
  19. Or Z, Jusot F, Yilmaz E, The European Union Working Group on Socioeconomic Inequalities in Health (2009) Inégalités sociales de recours aux soins en Europe: Quel rôle pour le système de soins? Revue Economique 60(2):521–543CrossRefGoogle Scholar
  20. Oxley H (2009) Policies for healthy ageing: an overview. OECD Health Working Papers, 42Google Scholar
  21. Palencia L, Espelt A, Rodriguez-Sanz M, Puigpinos R, Pons-Viques M, Pasarin IM, Spadea T, Kunst AE, Borell C (2010) Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol 39(3):757–765CrossRefGoogle Scholar
  22. Patel R, Lawlor DA, Ebrahim S (2007) Socio-economic position and the use of preventive health care in older British women: a cross-sectional study using data from the British Women’s Heart and Health Study cohort. Fam Pract 24(1):7–10CrossRefGoogle Scholar
  23. Spadea T, Bellini S, Kunst A, Stirbu I, Costa G (2010) The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Prev Med 50(4):159–164CrossRefGoogle Scholar
  24. Stirbu I, Kunst AE, Mielck A, Mackenbach JP (2007) Educational inequalities in preventives services among elderly in Europe. In: Tackling health inequalities in Europe: an integrated approach EUROTHINE, Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam, pp 483–499Google Scholar
  25. Taylor MF, Brice J, Buck N, Prentice-Lane E (2010) In: Taylor MF (ed) British household panel survey user manual. Vol A: introduction, technical report and appendices. University of Essex, ColchesterGoogle Scholar
  26. Van Doorslaer E, Koolman X (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 13(7):629–647CrossRefGoogle Scholar
  27. WHO (2008) The World Health Report 2008—Primary Health Care (Now More Than Ever)Google Scholar
  28. Zukevas S, Hill S (2004) Does capitation matter? Impacts on access, use and quality. Inquiry 41:316–335CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Université Paris-Dauphine, LEDA-LEGOS, Place du Maréchal de Lattre de Tassigny, 75 775 Paris Cedex 16, France & Irdes (Institute for Research and Information on Health Economics)ParisFrance
  2. 2.IRDES, Institute for Research and Information on Health EconomicsParisFrance

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