Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

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Abstract

Background

In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth.

Methods

The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression.

Results

We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women.

Conclusion

In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.

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Most cited references 11

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Inequalities in access to medical care by income in developed countries.

Eddy Van Doorslaer, Cristina Masseria, Xander Koolman (2006)

Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.

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The inverse care law.

J T Hart (1971)

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Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study.

Věra Skalická, Frank N. Van Leeuwen, Steinar Krokstad … (2009)

Previous studies have assessed the relative importance of material, psychosocial and behavioural factors in the explanation of relative socio-economic inequalities in mortality, but research into the contribution of biomedical factors has been limited. Our study examines the relative contribution of (i) material, (ii) psychosocial, (iii) behavioural and (iv) biomedical factors in the explanation of relative socio-economic (educational and income) inequalities in mortality. Cohort study--baseline data from the Norwegian total county population-based HUNT 2 study linked to mortality data (1995/97 to 2003). In this analysis, 18 247 men and 18 278 women aged 24-80 without severe chronic disease at baseline were eligible. No socio-economic inequalities in mortality among women were found. In men, educational- and income-related inequalities in mortality were found with a relative risk for the lowest educational group of 1.67 (1.29-2.15) and the lowest income quartile of 2.03 (1.57-2.70). Together, the four explanatory factors reduced the relative risk of mortality of the lowest educational group to 1.18 (0.90-1.55) and the relative risk of mortality in the lowest income quartile was attenuated to 1.17 (0.83-1.63). Known biomedical factors contributed least to both educational and income inequalities in mortality. Material factors were the most important in explaining income inequalities in mortality amongst men, whereas psychosocial and behavioural factors were the most important in explaining educational inequalities. This suggests that improving the material, psychosocial and behavioural circumstances of men might bring more substantial reductions in relative socio-economic inequalities in mortality.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central

ISSN (Electronic): 1475-9276

Publication date Collection: 2012

Publication date (Electronic): 22 August 2012

Volume: 11

Page: 48

Affiliations

[1 ]Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), MTFS, 7489, Trondheim, Norway

[2 ]HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

[3 ]Levanger Hospital, Nord-Trøndelag Health Authority, Trondheim, Norway

Article

Publisher ID: 1475-9276-11-48

DOI: 10.1186/1475-9276-11-48

PMC ID: 3490903

PubMed ID: 22909009

SO-VID: b88bacb1-2a0b-46df-adf8-461ce693d98c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

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Emerald: Healthier Lives

Most cited references 11

Inequalities in access to medical care by income in developed countries.

The inverse care law.

Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study.

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