This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

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Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition

https://pure.uva.nl/ws/files/3440051/3093_29236y.pdf

Predictors of health care utilization in the chronically ill: a review of the literature.

Health services utilization is determined by various factors. In order to study which factors are most important in different countries, a systematic review was conducted from 1970 to 1999. The mean number of visits, proportion of persons who see a doctor, and proportion that concentrate the most visits were similar. Children, childbearing-age women, and the elderly use health care services the most. Lower-income and less educated groups are also significantly associated with more frequent utilization. Increased health needs mediate more frequent utilization by these groups. However, the poorest groups may not receive adequate care, depending on the respective type of health system. Health need is one of the most important determinants in utilization, and if a health system's equity is to be analyzed, one must consider patterns of utilization among social groups in relation to the level of greatest need. Regularly visiting the same physician, a characteristic of accessibility to health care services, can determine more adequate utilization. This factor can reduce differences in health care among groups. The authors conclude by proposing a hierarchy of related factors.

/pdf/health-services-utilization-a-systematic-review-of-related-31seqdgh4s.pdf

Health services utilization: a systematic review of related factors

Measuring equity in access to health care

OBJETIVO: Identificar caracteristicas individuais associadas a maior probabilidade de consultar o medico e o fazer em excesso. METODOS: Estudo de base populacional com 3.100 adultos (>20 anos), moradores de Pelotas, Estado do Rio Grande do Sul, de outubro a dezembro de 2003. Foi utilizada amostragem por conglomerados em multiplos estagios. Foi realizada entrevista para obter dados socioeconomicos, demograficos e de saude, alem do numero de consultas no periodo de tres meses anteriores. A referencia de >4 consultas foi considerada superutilizacao. As analises multivariadas foram realizadas por regressao de Poisson baseadas em um modelo conceitual e apresentados em razoes de prevalencia e respectivos intervalos de confianca de 95%. RESULTADOS: A prevalencia de consulta ao medico foi de 55,1%. A maior probabilidade de consultar um medico esteve associada as mulheres, hospitalizacao no ano anterior, ex-tabagismo, diabetes e hipertensao arterial. Verificou-se tendencia de consultas conforme o avanco da idade (p<0,001) e piora da autopercepcao de saude (p<0,001). A prevalencia de superutilizacao de consultas foi de 9%, associada positivamente ao sexo feminino, hospitalizacao no ano anterior e historia de hipertensao. A tendencia de consultas em excesso esteve associada com aumento do indice de massa corporal (p=0,01), avanco da idade (p=0,006) e piora da autopercepcao de saude (p<0,001). CONCLUSOES: Estiveram associados a consulta e sua superutilizacao ser do sexo feminino, ser hipertenso e ter estado hospitalizado no ano anterior, alem do aumento de idade e piora da autopercepcao de saude.

https://www.scielosp.org/pdf/rsp/2006.v40n3/436-443/pt

Vittorio Mapelli

Papers

Health needs, demand for health services and expenditure across social groups in Italy: An empirical investigation

Money, medicine, and malpractice in American society