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Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008 - 2009


Devaux, M. and de Looper M.

Subject Keywords: Inequality, Health service
Topic: Health Inequalities
Health Inequalities
Type: Report
Region: International (other)

This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. It extends a previous analysis (Van Doorslaer and Masseria, 2004) to 2008-2009 for 13 countries, and adds new results for 6 countries, for doctor and dentist visits, and cancer screening. Quintile distributions and concentration indices were used to assess inequalities. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation. The paper considers the evolution of inequalities over time by comparing results with the previous study, as data permit. Health system financing arrangements are examined to see how these might affect inequalities in health service use.

Findings show that, for doctor visits, horizontal inequities in health care utilisation persist across OECD countries. After adjustment for needs for health care, the better-off are more likely to visit doctors, especially specialists. With GP contacts, the scenario is different. In most countries, for the same level of need for health care, the worse-off are as likely as the better-off to contact a GP, and they visit more often. Inequalities in dental visits and breast and cervical cancer screening appear in numerous countries, with the better-off making more use of services. The relative position of countries has remained stable for doctor and GP visits over the two studies. Some discrepancies are found in country ranks for specialist and dentist visits, but these are attributed to methodological differences.

Findings highlight the important effect that the financing of health care services can have on equity (public and private health insurance coverage, and the share of out-of-pocket payments for different services), although some of the inequalities in health service use cannot be explained by financial barriers.



Rights: © OECD
Suggested citation:

Devaux, M. and de Looper M.. (2012) Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008 - 2009 [Online]. Available from: [Accessed: 14th November 2019].


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