Income-Related Inequality in the Use of Medical Care in 21 OECD Countries

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. 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. In the majority ...