Inequalities in Utilisation of General Practitioner and Specialist Services in 9 European Countries

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2011 Nov 2

PMID 22040155

Citations 42

Authors

Irina Stirbu

Anton E Kunst

Andreas Mielck

Johan P Mackenbach

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions.

Methods: Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health.

Results: People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension.

Conclusions: We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases.

Citing Articles

Access points to different levels of health care over 13 years. Utilization behaviour in a changing health care system. Results of a three-wave cross-sectional series in Austria.

Kraxner R, Dorner T, Roth D, Hoffmann K Eur J Public Health. 2024; 35(1):11-18.

PMID: 39579124 PMC: 11832157. DOI: 10.1093/eurpub/ckae180.

Health care utilization up to 11 years after diagnosis among patients with a hematologic malignancy and its association with socioeconomic position.

Ekels A, van de Poll-Franse L, Issa D, Oosterveld M, van der Griend R, Hoogendoorn M J Cancer Surviv. 2024; .

PMID: 39287915 DOI: 10.1007/s11764-024-01676-2.

Central and Eastern European Migrants in the United Kingdom: A Scoping Review of the Reasons for Utilisation of Transnational Healthcare.

Stepanova V, Poppleton A, Ponsford R Health Expect. 2024; 27(4):e14155.

PMID: 39044675 PMC: 11266902. DOI: 10.1111/hex.14155.

Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe.

Ares-Blanco S, Lopez-Rodriguez J, Polentinos-Castro E, Del Cura-Gonzalez I BMC Prim Care. 2024; 25(1):165.

PMID: 38750446 PMC: 11094967. DOI: 10.1186/s12875-024-02400-w.

Polypharmacy Is Associated with Sociodemographic Factors and Socioeconomic Status in United States Adults.

Vennu V Pharmacy (Basel). 2024; 12(2).

PMID: 38525729 PMC: 10961768. DOI: 10.3390/pharmacy12020049.

References

Goddard M, Smith P . Equity of access to health care services: theory and evidence from the UK. Soc Sci Med. 2001; 53(9):1149-62. DOI: 10.1016/s0277-9536(00)00415-9. View

Reijneveld S, Stronks K . The impact of response bias on estimates of health care utilization in a metropolitan area: the use of administrative data. Int J Epidemiol. 2000; 28(6):1134-40. DOI: 10.1093/ije/28.6.1134. View

Forrest C, Nutting P, von Schrader S, Rohde C, Starfield B . Primary care physician specialty referral decision making: patient, physician, and health care system determinants. Med Decis Making. 2006; 26(1):76-85. DOI: 10.1177/0272989X05284110. View

van Doorslaer E, Jones A . Income-related inequality in health and health care in the European Union. Health Econ. 2004; 13(7):605-8. DOI: 10.1002/hec.917. View

Boshuizen H, Viet A, Picavet H, Botterweck A, van Loon A . Non-response in a survey of cardiovascular risk factors in the Dutch population: determinants and resulting biases. Public Health. 2005; 120(4):297-308. DOI: 10.1016/j.puhe.2005.09.008. View

Saha S, Arbelaez J, Cooper L . Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003; 93(10):1713-9. PMC: 1448039. DOI: 10.2105/ajph.93.10.1713. View

Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, De Graeve D, DuChesne I . Equity in the delivery of health care in Europe and the US. J Health Econ. 2001; 19(5):553-83. DOI: 10.1016/s0167-6296(00)00050-3. View

Martikainen P, Laaksonen M, Piha K, Lallukka T . Does survey non-response bias the association between occupational social class and health?. Scand J Public Health. 2007; 35(2):212-5. DOI: 10.1080/14034940600996563. View

Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J . Influence of context effects on health outcomes: a systematic review. Lancet. 2001; 357(9258):757-62. DOI: 10.1016/s0140-6736(00)04169-6. View

10.

Wong M, Asch S, Andersen R, Hays R, Shapiro M . Racial and ethnic differences in patients' preferences for initial care by specialists. Am J Med. 2004; 116(9):613-20. DOI: 10.1016/j.amjmed.2003.09.051. View

11.

Little P, Dorward M, Warner G, Stephens K, Senior J, Moore M . Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study. BMJ. 2004; 328(7437):444. PMC: 344266. DOI: 10.1136/bmj.38013.644086.7C. View

12.

van Doorslaer E, Masseria C, Koolman X . Inequalities in access to medical care by income in developed countries. CMAJ. 2006; 174(2):177-83. PMC: 1329455. DOI: 10.1503/cmaj.050584. View

13.

Drivsholm T, Eplov L, Davidsen M, Jorgensen T, Ibsen H, Hollnagel H . Representativeness in population-based studies: a detailed description of non-response in a Danish cohort study. Scand J Public Health. 2006; 34(6):623-31. DOI: 10.1080/14034940600607616. View

14.

Butler C, Rollnick S, Pill R, Stott N . Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ. 1998; 317(7159):637-42. PMC: 28658. DOI: 10.1136/bmj.317.7159.637. View

15.

Reijneveld S, Stronks K . The validity of self-reported use of health care across socioeconomic strata: a comparison of survey and registration data. Int J Epidemiol. 2002; 30(6):1407-14. DOI: 10.1093/ije/30.6.1407. View

16.

Wagstaff A, Doorslaer E, van der Burg H, Calonge S, Christiansen T, Citoni G . Equity in the finance of health care: some further international comparisons. J Health Econ. 1999; 18(3):263-90. DOI: 10.1016/s0167-6296(98)00044-7. View

17.

Groholt E, Stigum H, Nordhagen R, Kohler L . Health service utilization in the Nordic countries in 1996: Influence of socio-economic factors among children with and without chronic health conditions. Eur J Public Health. 2003; 13(1):30-7. DOI: 10.1093/eurpub/13.1.30. View

18.

Meryn S . Improving doctor-patient communication. Not an option, but a necessity. BMJ. 1998; 316(7149):1922. PMC: 1113402. DOI: 10.1136/bmj.316.7149.1922. View

19.

McKee M, Shkolnikov V . Understanding the toll of premature death among men in eastern Europe. BMJ. 2001; 323(7320):1051-5. PMC: 1121549. DOI: 10.1136/bmj.323.7320.1051. View

20.

Nolte E, Scholz R, Shkolnikov V, Mckee M . The contribution of medical care to changing life expectancy in Germany and Poland. Soc Sci Med. 2002; 55(11):1905-21. DOI: 10.1016/s0277-9536(01)00320-3. View