Explaining income-related inequalities in doctor utilisation in Europe.

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). 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 generalised Negbin models. 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 to other factors. Despite decades of universal and fairly comprehensive coverage in European countries, utilisation patterns suggest that rich and poor are not treated equally. Copyright 2004 John Wiley & Sons, Ltd.