Screening Tests, Information, and the Health-Education Gradient

The association between health outcomes and education – the health-education gradient - is widely documented but little is known about its source. Using microeconomic data on a sample of individuals aged 50+ in eight European countries, we find that education and cognitive skills (such as verbal fluency) are associated with a greater propensity for standard screening tests (mammography and colonoscopy). In order to study the role of information on the decision to screen, we test whether the health-education gradient varies with the quality of the information provided by the health care system, as proxied by the quality of the General Practitioner. Using an Instrumental Variable approach to control for the potential endogeneity of the GP quality score, we find evidence of a strong and significant complementarity between education and quality of primary care. We interpret this result as evidence that health-education gradient can be explained, at least in part, by the fact that better educated individuals are more able to process and internalize health related information as provided by GPs.