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

Keywords: 

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 medicines. The 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 finding.

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.