Socioeconomic Inequalities in Primary-care and Specialist Physician Visits: a Systematic Review

Overview

Journal Int J Equity Health

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2021 Feb 11

PMID 33568126

Citations 57

Authors

Sara Lena Lueckmann

Jens Hoebel

Julia Roick

Jenny Markert

Jacob Spallek

Olaf von dem Knesebeck

Matthias Richter

Affiliations

Soon will be listed here.

Abstract

Background: Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.

Methods: We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.

Results: Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.

Conclusion: This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.

Prospero Registration Number: CRD42019123222 .

Citing Articles

Social Factors, Age, and Health at Time of Dementia Diagnosis.

Ding M, Schmidt-Mende K, Modig K JAMA Netw Open. 2025; 8(2):e2461117.

PMID: 39982724 PMC: 11846011. DOI: 10.1001/jamanetworkopen.2024.61117.

Diabetic Retinopathy Disease Burden in Patients With Lower Household Incomes vs Higher Household Incomes.

Patel H, Allen A, Karl J, Weng P, Stinnett S, Rosdahl J J Vitreoretin Dis. 2025; 24741264241309683.

PMID: 39790837 PMC: 11707756. DOI: 10.1177/24741264241309683.

Influence of Health System Affiliation and Pain Manifestation on Advanced Oral Cavity Squamous Cell Carcinoma Risk: A Retrospective Cohort Study in a Latin American Population.

Diaz-Laclaustra A, Alvarez-Martinez E, Ardila C Dent J (Basel). 2024; 12(12).

PMID: 39727439 PMC: 11674064. DOI: 10.3390/dj12120383.

Experiences in healthcare for weight management - a qualitative interview study of retired individuals with obesity and low or high education.

Nordquist H, Joki A, Salmela J, Lallukka T BMC Health Serv Res. 2024; 24(1):1285.

PMID: 39462392 PMC: 11515097. DOI: 10.1186/s12913-024-11777-4.

Physician-to-Physician eConsultations to Ophthalmologists at an Academic Medical Center.

Sherif N, Lorch A, Armstrong G Transl Vis Sci Technol. 2024; 13(10):13.

PMID: 39377754 PMC: 11463702. DOI: 10.1167/tvst.13.10.13.

References

Vikum E, Bjorngaard J, Westin S, Krokstad S . Socio-economic inequalities in Norwegian health care utilization over 3 decades: the HUNT Study. Eur J Public Health. 2013; 23(6):1003-10. DOI: 10.1093/eurpub/ckt053. View

Tavares L, Zantomio F . Inequity in healthcare use among older people after 2008: The case of southern European countries. Health Policy. 2017; 121(10):1063-1071. DOI: 10.1016/j.healthpol.2017.08.011. View

Schroder S, Fink A, Richter M . Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients. BMJ Open. 2018; 8(11):e024151. PMC: 6252635. DOI: 10.1136/bmjopen-2018-024151. View

Lu J, Leung G, Kwon S, Tin K, van Doorslaer E, ODonnell O . Horizontal equity in health care utilization evidence from three high-income Asian economies. Soc Sci Med. 2006; 64(1):199-212. DOI: 10.1016/j.socscimed.2006.08.033. View

Mackenbach J . Re-thinking health inequalities. Eur J Public Health. 2020; 30(4):615. PMC: 7445033. DOI: 10.1093/eurpub/ckaa001. View

Vedsted P, Fink P, Sorensen H, Olesen F . Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study. Soc Sci Med. 2004; 59(4):813-23. DOI: 10.1016/j.socscimed.2003.11.027. View

Vedsted P, Olesen F . Social environment and frequent attendance in Danish general practice. Br J Gen Pract. 2005; 55(516):510-5. PMC: 1472799. View

Stirbu I, Kunst A, Mielck A, Mackenbach J . Inequalities in utilisation of general practitioner and specialist services in 9 European countries. BMC Health Serv Res. 2011; 11:288. PMC: 3221557. DOI: 10.1186/1472-6963-11-288. View

Kim S, Park J, Lee Y, Seo H, Sheen S, Hahn S . Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol. 2013; 66(4):408-14. DOI: 10.1016/j.jclinepi.2012.09.016. View

10.

Bago dUva T, Jones A, van Doorslaer E . Measurement of horizontal inequity in health care utilisation using European panel data. J Health Econ. 2008; 28(2):280-9. DOI: 10.1016/j.jhealeco.2008.09.008. View

11.

Schroder S, Richter M, Schroder J, Frantz S, Fink A . Socioeconomic inequalities in access to treatment for coronary heart disease: A systematic review. Int J Cardiol. 2016; 219:70-8. DOI: 10.1016/j.ijcard.2016.05.066. View

12.

Dowd J, Zajacova A . Does self-rated health mean the same thing across socioeconomic groups? Evidence from biomarker data. Ann Epidemiol. 2010; 20(10):743-9. PMC: 4845753. DOI: 10.1016/j.annepidem.2010.06.007. View

13.

Rattay P, Butschalowsky H, Rommel A, Prutz F, Jordan S, Nowossadeck E . [Utilization of outpatient and inpatient health services in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013; 56(5-6):832-44. DOI: 10.1007/s00103-013-1665-x. View

14.

Lostao L, Regidor E, Gimeno D, Netuveli G, Blane D . Socioeconomic patterns in health services use in Great Britain and Spain before and after the health system reforms of the 1990s. Health Place. 2011; 17(3):830-5. DOI: 10.1016/j.healthplace.2011.03.006. View

15.

Beckman A, Anell A . Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits. BMC Health Serv Res. 2013; 13:452. PMC: 4228471. DOI: 10.1186/1472-6963-13-452. View

16.

Garrido-Cumbrera M, Borrell C, Palencia L, Espelt A, Rodriguez-Sanz M, Pasarin M . Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system. Int J Health Serv. 2010; 40(3):525-42. DOI: 10.2190/HS.40.3.h. View

17.

Abasolo I, Saez M, Lopez-Casasnovas G . Financial crisis and income-related inequalities in the universal provision of a public service: the case of healthcare in Spain. Int J Equity Health. 2017; 16(1):134. PMC: 5525232. DOI: 10.1186/s12939-017-0630-y. View

18.

Scott A, Chambers D, Goyder E, OCathain A . Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review. PLoS One. 2017; 12(5):e0177210. PMC: 5425027. DOI: 10.1371/journal.pone.0177210. View

19.

Ryvicker M, Gallo W, Fahs M . Environmental factors associated with primary care access among urban older adults. Soc Sci Med. 2012; 75(5):914-21. PMC: 3383917. DOI: 10.1016/j.socscimed.2012.04.029. View

20.

Wu S, Wang R, Zhao Y, Ma X, Wu M, Yan X . The relationship between self-rated health and objective health status: a population-based study. BMC Public Health. 2013; 13:320. PMC: 3637052. DOI: 10.1186/1471-2458-13-320. View