Explaining Income-Related Inequalities in Doctor Utilisation in Europe: A Decomposition Approach

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IZA Seminar

Place: Schaumburg-Lippe-Str. 9, 53113 Bonn

Date: 11.02.2003, 12:15 - 13:30


Presentation by 

Eddy van Doorslaer (Erasmus University Rotterdam)
Xander Koolman (Erasmus University Rotterdam)


This paper presents new international comparative evidence on the factors driving inequalities in the use of GP and specialist services in 12 EU member states. The data are taken from the 1996 wave of the European Community Household Panel (ECHP). A new method to decompose observed inequality is used to identify the sources of inequality and to obtain estimates of an index of horizontal inequity. We examine two types of utilisation (the probability of a visit and the conditional number of positive visits) for two types of medical care: general practitioner and medical specialist visits using probit, truncated Negbin and generalized Negbin models. Bootstrapping is used for statistical inference on the contributions to inequality. We find little or no evidence of income-related inequity in the probability of a GP visit in these countries. Conditional upon at least one visit, there is even evidence of a somewhat pro-poor distribution. By contrast, substantial pro-rich inequity emerges in virtually every country with respect to the probability of contacting a medical specialist. Despite their lower needs for such care, wealthier and higher educated individuals appear to be much more likely to see a specialist than the less well-off. This phenomenon is universal in Europe, but stronger in countries where either private insurance cover or private practice options are offered to purchase quicker and/or preferential access. Pro-rich inequity in subsequent visits adds to this access inequity but appears more related to regional disparities in utilisation than other factors. All in all, the evidence suggests that European countries appear to have achieved their equity goals of removing income barriers and equalizing access to GP care, either through positive discrimination or through regional distribution. But the same cannot be said about specialist care: the wealthier continue to enjoy greater access to medical specialist care in almost all countries, and this phenomenon is fuelled by regional disparities in availability of such care in some of the countries.

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