Patient cost sharing and physician visits by socioeconomic position: findings in three Western European countries.

The association between educational level and the probability of physician visits in three Western European countries, one of which has a system of patient cost sharing was evaluated. Cross-sectional surveys were performed in France, Germany and Spain around 1990 and around 2000. People representative of the French, German and Spanish populations, aged 25-74 years were studied. The probability of physician visits decreased in the second period with respect to the first in France and Germany, but it increased in Spain. In the two periods studied, subjects with low educational level had a lower probability of physician visits than those with high educational level in France, in contrast with the general trend in Germany and Spain. In both periods, France had patient cost sharing whereas Germany and Spain did not. The existence of patient cost sharing in the healthcare systems of Western European countries raises doubts about the possibility of making use of health services independent of individual socioeconomic position.