Impact of health-care system on social inequalities in care utilizations

Rational: In Europe it is well documented that significant inequalities exist in the use of health-care services across socio-economic groups. There is also evidence that the degree of this inequality in access to care varies significantly from one country to other. Nevertheless, in previous work little attention is paid to the role of the health-care system in explaining these differences. Moreover little comparative information is available on different type of health service utilization such as preventive care by different social groups.

The objective of this paper is to provide new evidence on social inequalities in preventive-care utilization and assess the role of health system in determining health-care use by different socio-economic groups, exploring new data and indicators.

Methodology: The data for this study come from the SHARE 2006 (Survey of Health, Aging and Retirement in Europe) which provides comparable data on persons aged 50 and over in 13 European countries. We examine four indicators of preventive-care: flu vaccination, eye examination, mammography and colonoscopy, in addition to visits to general practitioners and specialists.

The health system variables examined are: existence of a gatekeeping system; level of public funding, methods of paying doctors and financing health care system (tax versus social insurance).

Multilevel logistic models are used to test the impact of differences in national health-care systems in explaining social inequalities in preventive care use.

Conclusion: This paper develops a framework for studying the impact of various health care characteristics on access to care and provides new results. Results show that there are significant cross-country disparities in the degree of social inequalities in preventive care use, and health care systems can play an important role in reducing inequities in health care. It appears that the GPs position in health system is an important element.