Inequality in health service utilization - a preliminary study

This report aims at surveying social inequalities in health service utilization. Income appears to be a stronger marker for inequalities in health service utilization than education. The correlations vary according to type of health service, and according to gender, age and health status. Generally speaking, groups with less than good health, as expected, use health services to a greater extent than groups with good health. Women use health services more than men, and older people use more health services than younger people.

There is a marked social gradient in health services utilization by income for groups with less than good health. There are more marked differences among older people. Among young people (under 45 years) the differences in health service utilization by education and income are not as pronounced. For people 45 years and older there is a reversed social gradient by income in use of GP, but not by education. The difference between the groups is less pronounced when we look at repeated use of services. There is a clear social gradient by education in use of physiotherapists, and lower utilization in the lowest income group. There is a social gradient in the use of specialists by both education and income. There is a strong reversed gradient in hospital admissions, but when we look at time spent in hospital there are no differences by income. Young people with less than good health and lower education are the most frequent users of psychologists. There is a marked social gradient in the use of dentists by both income and education.

Groups with higher education use more non-prescription medicines, while the percentage using prescription medicines is markedly higher among groups with lower education. Prescription medicines are used far more among people 45 years and older and in groups with lower education, compared to younger people.

More people in the highest educational group were vaccinated against influenza during the last 12 months, even when controlling for health status and age. Women and people 45 years and older were more likely than others to have tested their blood pressure, blood sugar and cholesterol. There is, however, a social gradient in the use of different tests by income.

Most people feel that they get sufficient health care. More among the young than among the old have an unmet need for health care. The most common reason for unmet need for care from a doctor is that it takes too long to get an appointment, and that people do not have time to see the doctor because of work or family obligations. Among those with an unmet need for dental care half of them say they could not afford to see a dentist. This is most common among people with low income. Very few have not been able to collect prescription medicine at the pharmacy because they could not afford it. In groups with less than good health there is a strong social gradient.

There is a high degree of satisfaction with the health services. Groups with high income are more satisfied with the doctor than groups with lower income. A majority agrees that the doctor takes their problems seriously, and gives them referral to specialist if needed. Most patients also feel that they get enough time with their doctor. More than twice as many in the lowest income group feel that they get too little time with the doctor compared to the highest income group, and more among the old than the young feel they get too little time with their doctor.