Unequal Access to Medical Care in the OECD Countries
(2004) , 89 pages
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- Authors
- Abstract
- 1. This study updates and extends a previous study on equity in physician utilisation for a subset of the countries analyzed here (Van Doorslaer, Koolman and Puffer, 2002). It updates results to 2000 for 13 countries and adds new results for eight countries: Australia, Finland, France, Hungary, Mexico, Norway, Switzerland and Sweden. Both simple quintile distributions and concentration indices were used to assess horizontal equity, i.e. the extent to which adults in equal need for physician care appear to have equal rates of medical care utilisation. 2. With respect to physician utilisation, need is more concentrated among the worse off, but after “standardizing out” these need differences, significant horizontal inequity favoring the better off is found in about half of the countries, both for the probability and the total number of visits. The degree of pro-rich inequity in doctor use is highest in the US, followed by Mexico, Finland, Portugal and Sweden. 3. In the majority of countries, the study finds no evidence of inequity in the distribution of GP visits across income groups and where significant horizontal inequity (HI) appears to exist, it is often negative, indicating a pro-poor distribution. The picture is very different with respect to consultations of a medical specialist. In all countries, controlling for need differences, the rich are significantly more likely to see a specialist than the poor, and in most countries also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. The story emerging for inpatient care utilisation is more equivocal. No clear pattern for either pro-rich or pro-poor inequity emerges across countries, nor is it obvious how to account for the observed patterns in terms of different health system characteristics. 4. Finally, the study finds a pro-rich distribution of both the probability and the frequency of dentist visits in all OECD countries. There is, however, wide variation in the degree to which this occurs. Using a decomposition method, the study assessed the contribution of regional disparities in use and, for seven of the countries, of income-related disparities in (public and private) health insurance coverage.
- Affiliations
IRDES Institut de Recherche et de Documentation en Economie de la Santé
Citations
Van Doorslaer, E., Masseria, C., Koolman, X., Lafortune, G., Clarke, P., Gerdtham, UG., H akkinen, U., Tubeuf, S., Dourgnon, P., Schellhorn, M., Szende, A., Nigenda, G., Arreola, H., Grasdal, A., Leu, R., Puffer, F., & Seidler, E. (2004). Unequal Access to Medical Care in the OECD Countries. OECD. https://hdl.handle.net/2078.5/59720