Inequity in the use of physician services in Norway. Changing patterns over time

We analyze and compare inequity in use of physician visits (GP and specialists) in Norway based on data from the Surveys of Living Conditions for the years 2000, 2002 and 2005. Within this period the Norwegian public health care system underwent two major reforms, both aimed at ensuring equitable access to health care services for the entire population. A list patient system was introduced in the primary health care sector in 2001, and in 2002 the ownership of hospitals was moved from the regional to the state level. At both care levels a real increase in public expenditures followed in the wake of the reforms. We apply the indirect standardization approach and estimate the relationship between health care use, need and other control variables by linear and nonlinear regression. We measure horizontal inequity in physician visits by concentration indices and investigate changes in inequity over time when decomposing the concentration indices into the contribution of its determinants. For specialist services we find pro-rich inequity in the probability of seeing an outpatient specialist in all three years. Estimated concentration indices are reduced in magnitude over time and no longer statistically significant in 2005. Inclusion of more information about need for medical care in 2002 and 2005, results in larger and statistical significant concentration indices. In sum, in a period with important changes in the health care system aimed at obtaining equity, inequity in medical specialist utilization has been reduced but not removed in Norway. §