Does household income affect access to medical care in developed countries?In this study, members of the Organization for Economic Cooperation and Development (OECD) health equity research group examined access to general practitioners and medical specialists in 21 OECD countries.
After taking into account the age, sex and reported level of health of respondents to national surveys, the authors found that – although in many countries general practitioner care is distributed fairly equally and is often even pro-poor (more visits among poorer households) – in all countries surveyed, higher-income people are so much more likely to seek specialist care than lower-income people that total doctor utilization is somewhat pro-rich. The authors also found that this general finding tends to be reinforced in countries where private insurance or private care options are offered. The degree of pro-rich inequity was highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In Canada, as in most countries, there was a pro-poor bias in access to general practitioner care but a pro-rich bias when it came to access to specialty care.
Graphics are available (by country with histograms of inequity).
In an accompanying editorial, Jeremiah Hurley and Michel Grignon of McMaster University suggest that the results of the OECD study caution "against any illusion that parallel private insurance will increase access for anyone except the higher-income people who purchase it."
p. 177 Inequalities in access to medical care by income in developed countries -- E. van Doorslaer et al http://www.cmaj.ca/pressrelease/pg177.pdf
p. 187 Income and equity of access to physician services -- J. Hurley, M. Grignon
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