APH 2001, 59, 309-328:
Income-related inequalities and inequities in health care utilisation: Belgium and the Netherlands compared.
E. Van Doorslaer, J. Buytendijk and J. Geurts
|The Belgian Health
Interview Survey held in 1997 is very comparable to the Netherlands
Health Interview Survey 1997. We use data from both surveys to compare
levels and distributions of health care utilization in both countries.
In addition to testing for differences in level and distribution of
medical care utilization, this study also examines whether any of these
differences are attributable to differences in health care system characteristics.
Need-standardised concentration indices are used to measure the degree
of income-related inequality and inequity. The findings are that, in
general, Belgians are more intensive users of the health care system,
with a higher use of the GP, the specialist, the hospital and prescribed
Dutch, on the other hand, report more frequent contacts with the
dentist. No significant inequity is found for the utilization of GP or
hospital inpatient care. Significant inequity is observed in both
countries with respect to the number of specialist contacts only: higher
income individuals make more use of specialist services than expected
on the basis of predicted need. The degree of such inequitable
specialist use is remarkably similar given the substantial differences
in referral systems, copayments and doctor availability between both
countries. Neither the abundant supply and direct accessibility of
medical specialists in Belgium, nor the private insurance status of
higher income individuals in the Netherlands can account for this
Conclusion: Despite substantial system differences, there are also remarkable similarities in utilisation patterns by income in both countries. For GP and inpatient hospital use, equal access for equal need, irrespective of income, appears to hold, but not for the specialist. Other factors than delivery system characteristics, like, for instance, differential care preferences or quality perceptions between rich and poor, may be responsible for the higher-than-expected use of medical specialist services by higher income individuals.