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Patient cost sharing and social inequalities in access to health care in three western European countries

Listed author(s):
  • Lostao, Lourdes
  • Regidor, Enrique
  • Geyer, Siegfried
  • Aïach, Pierre
Registered author(s):

    This study evaluates the association between social class and health services use in France, Germany and Spain, three countries with universal health coverage but with different cost-sharing systems. In France, patients share the cost of both physician visits and hospitalization, in Germany they share the cost of hospitalization, and in Spain there is no system of patient cost sharing. The data were obtained from national health surveys carried out in each of these countries during the last decade of the 20th century. We found that persons belonging to a low social class had fewer physician visits than those belonging to a high social class in France, whereas the opposite occurred in Germany and Spain. After adjusting for a measure of the need for health care, the results in France changed little, whereas no significant differences by social class were seen in Germany and Spain. Persons of low social class had more hospital admissions than those of high social class in France and Spain, while no statistically different differences were seen in Germany. After adjusting for need, no significant differences were seen in any of the three countries. Although other factors related with the structure of the health system can not be ruled out, our findings suggest that patient cost sharing reduces the frequency of physician visits and that this decrease is greater in the low social classes, whereas the effect of co-payment for hospitalization on the frequency of hospital admission is not clear.

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    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(07)00262-6
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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 65 (2007)
    Issue (Month): 2 (July)
    Pages: 367-376

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    Handle: RePEc:eee:socmed:v:65:y:2007:i:2:p:367-376
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    1. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    2. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
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    4. Luis Ayala & Jesús Ruiz Huerta & Rosa Martínez, 1998. "El mercado de trabajo y la distribución personal de la renta en España en los años noventa," EKONOMIAZ. Revista vasca de Economía, Gobierno Vasco / Eusko Jaurlaritza / Basque Government, vol. 40(01), pages 104-133.
    5. Thomas C. Buchmueller & Agnès Couffinhal & Michel Grignon & Marc Perronin, 2002. "Access to Physician Services: Does Supplemental Insurance Matter? Evidence from France," NBER Working Papers 9238, National Bureau of Economic Research, Inc.
    6. van der Meer, Joost B. W. & van den Bos, Johannes & Mackenbach, Johan P., 1996. "Socioeconomic differences in the utilization of health services in a Dutch population: the contribution of health status," Health Policy, Elsevier, vol. 37(1), pages 1-18, July.
    7. Rainer Winkelmann, 2004. "Co-payments for prescription drugs and the demand for doctor visits - Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1081-1089.
    8. Cherkin, Daniel C. & Grothaus, Louis & Wagner, Edward H., 1992. "Is magnitude of co-payment effect related to income? Using census data for health services research," Social Science & Medicine, Elsevier, vol. 34(1), pages 33-41, January.
    9. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
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