Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s?

Swedish health policy emphasises equity in health and health care. During the 1990s considerable changes have taken place in the organisation and delivery of Swedish health care and user fees have increased. Did patterns of health care utilisation across income groups change during the 1990s? Health care utilisation was measured from three questions in the Swedish Survey of Living Conditions 1988/89 and 1996/97: having seen a doctor in the last 3 months; having been hospitalised in the last 3 months; and having sought emergency care in the last 3 months. An additional question concerned having needed but not sought medical care in the last 3 months. Age standardised prevalence rates and adjusted odds ratios for utilisation were calculated for the whole sample and among persons with limiting longstanding illness, by income quintiles. Results suggest a possible increase in inequalities in utilisation of health services, to the disadvantage of low income groups. An inverse income gradient which was not evident in 1988/89 appeared in 1996/97 in having needed but not sought medical care. Further specific studies are warranted to monitor emerging inequalities in access to and utilisation of health care in Sweden.