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Socioeconomic inequality of diabetes patients’ health care utilization in Denmark


  • Camilla Sortsø

    (University of Southern Denmark
    Institute of Applied Economics and Health Research (ApEHR))

  • Jørgen Lauridsen

    () (University of Southern Denmark)

  • Martha Emneus

    (Institute of Applied Economics and Health Research (ApEHR))

  • Anders Green

    (Institute of Applied Economics and Health Research (ApEHR)
    Odense University Hospital and University of Southern Denmark)

  • Peter Bjødstrup Jensen

    (Institute of Applied Economics and Health Research (ApEHR))


Understanding socioeconomic inequalities in health care is critical for achieving health equity. The aim of this paper is threefold: 1) to quantify inequality in diabetes health care service utilization; 2) to understand determinants of these inequalities in relation to socio-demographic and clinical morbidity factors; and 3) to compare the empirical outcome of using income level and educational level as proxies for Socio Economic Status (SES). Data on the entire Danish population of diabetes patients in 2011 (N = 318,729) were applied. Patients’ unique personal identification number enabled individual patient data from several national registers to be linked. A concentration index approach with decomposition into contributing factors was applied. Differences in diabetes patients’ health care utilization patterns suggest that use of services differ among patients of lower and higher SES, despite the Danish universal health care system. Especially, out-patient services, rehabilitation and specialists in primary care show different utilization patterns according to SES. Comparison of the empirical outcome from using educational level and income level as proxy for patients’ SES indicate important differences in inequality estimates. While income, alike other measures of labor market attachment, to a certain extent is explained by morbidity and thus endogenous, education is more decisive for patients’ ability to take advantage of the more specialized services provided in a universal health care system.

Suggested Citation

  • Camilla Sortsø & Jørgen Lauridsen & Martha Emneus & Anders Green & Peter Bjødstrup Jensen, 2017. "Socioeconomic inequality of diabetes patients’ health care utilization in Denmark," Health Economics Review, Springer, vol. 7(1), pages 1-22, December.
  • Handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0155-5
    DOI: 10.1186/s13561-017-0155-5

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    References listed on IDEAS

    1. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    2. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income‐related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628, July.
    3. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    4. Philip Clarke & Tom Van Ourti, 2009. "Correcting the Bias in the Concentration Index when Income is Grouped," CEPR Discussion Papers 599, Centre for Economic Policy Research, Research School of Economics, Australian National University.
    5. ERREYGERS, Guido & KESSELS, Roselinde, 2013. "Regression-based decompositions of rank-dependent indicators of socioeconomic inequality of health," Working Papers 2013007, University of Antwerp, Faculty of Business and Economics.
    6. Sortsø, Camilla & Lauridsen, Jørgen & Emneus, Martha & Green, Anders & Jensen, Peter Bjødstrup, 2016. "Decomposing Inequality in Diabetes Patients' Morbidity Patterns, Survival and Health Care Usage in Denmark," DaCHE discussion papers 2016:2, University of Southern Denmark, Dache - Danish Centre for Health Economics.
    7. Adam Wagstaff & Eddy van Doorslaer, 2004. "Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 297-301, March.
    8. Clarke, Philip M. & Gerdtham, Ulf-G. & Johannesson, Magnus & Bingefors, Kerstin & Smith, Len, 2002. "On the measurement of relative and absolute income-related health inequality," Social Science & Medicine, Elsevier, vol. 55(11), pages 1923-1928, December.
    9. ERREYGERS, Guido & KESSELS, Roselinde, 2015. "Socioeconomic status and health: A new approach to the measurement of bivariate inequality," Working Papers 2015017, University of Antwerp, Faculty of Business and Economics.
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    Cited by:

    1. Olsen, Kim Rose & Laudicella, Mauro, 2019. "Health care inequality in free access health systems: The impact of non-pecuniary incentives on diabetic patients in Danish general practices," Social Science & Medicine, Elsevier, vol. 230(C), pages 174-183.


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