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Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries

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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.

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  1. Although the inclusion of private health insurance in the specification of the model may create an endogeneity problem due to selection effect, a sensitivity analysis showed that the findings were robust. We replicated the analysis without including insurance and found that the overall results for the measure of inequities were unchanged.

  2. Detail on the construction of equalised income in Canada and EHIS countries is available on demand.

  3. The analysis was also carried out with the Erreygers index. Results were broadly similar.

  4. Only in England, Scotland and Wales.

  5. For people with statutory health insurance.

  6. In New Zealand, specialist visits, in contrast to GP visits, are exempted from co-payments.

  7. The small sample size in the Czech Republic and Slovenia prevents detection of significant differences.


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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.

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Correspondence to Marion Devaux.

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The content of this paper does not necessarily reflect the views of the OECD or of the governments of its member countries.

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Devaux, M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ 16, 21–33 (2015).

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