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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2018

Open Access 01-12-2018 | Research

Use of health services according to income before and after elimination of copayment in Germany and restriction of universal health coverage in Spain

Authors: Lourdes Lostao, Siegfried Geyer, Romana Albaladejo, Almudena Moreno-Lostao, Elena Ronda, Enrique Regidor

Published in: International Journal for Equity in Health | Issue 1/2018

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Abstract

Background

In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country.

Methods

Data were taken from the 2009 and 2014 Socio-Economic Panel conducted in Germany, and from the 2009 and 2014 European Health Surveys in Spain. The health services investigated were physician consultations and hospital admissions, and the measure of socioeconomic position used was household income. The magnitude of the relationship between socioeconomic position and the use of each health service in people from 16 to 74 years old was estimated by calculating the percentage ratio using binary regression.

Results

In Germany, after adjusting for age, sex, and need for care, in the model comparing the two lower income categories to the two higher categories, the percentage ratio for physician consultation was 0.97 (95% CI 0.96–0.99) in 2009 and 0.98 (95% CI 0.97–0.99) in 2014, and the percentage ratio for hospitalization was 1.01 (95% CI 0.93–1.10) in 2009 and 1.16 (95% CI 1.08–1.25) in 2014. In Spain, after adjusting for age, sex, and self-rated health, the percentage ratio for physician consultation was 0.99 (95% CI 0.94–1.05) in 2009 and 1.08 (95% CI 1.03–1.14) in 2014, and the percentage ratio for hospitalization was 1.04 (95% CI 0.92–1.18) in 2009 and 0.99 (95% CI 0.87–1.14) in 2014.

Conclusion

The results suggest that elimination of the copayment in Germany did not change the frequency of physician consultations, whereas after the restriction of universal health coverage in Spain, subjects with lower incomes had a higher frequency of physician consultations.
Literature
1.
2.
Finkelstein MM. Do factors other than need determine utilization of physician services in Ontario? CMAJ. 2001;165:565–70.PubMedPubMedCentral
3.
Van Der Heyden S, Demarest J, Tafforeau H, Van Oyen H. Socio-economic differences in the utilization of health services in Belgium. Health Policy. 2003;65:153–65.CrossRefPubMed
4.
Sutton M, Gravelle H, Morris S, Leyland A, Windmeijer F, Dibben C. Allocation of resources to English areas. Edinburgh: Department of Health, Information and Service Division; 2002.
5.
Van Doorslaer E, Masseria C, OECD Health Equity Research Group Members. Income-related inequality in the use of medical care in 21 OECD countries. Health working paper no 14. Paris: OECD; 2004.CrossRef
6.
Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med. 2005;60:1251–66.CrossRefPubMed
7.
8.
Cylus J, Mladovsky P, McKee M. Is there a statistical relationship between economic crises and changes in government health expenditure growth? An analysis of twenty-four European countries. Health Serv Res. 2012;47:2204–24.CrossRefPubMedPubMedCentral
9.
10.
Heuer J. Placebo oder Wunderpille? Wie die Praxisgebühr Patientenverhalten und Verordnungsmuster veränderte. [Placebo or wonderpill? How the supplementary payment changed patient behaviour and prescription patterns]. Berlin: Zentralinstitut für die Kassenärztliche Versorgung. 2016(8).
11.
12.
13.
Legido-Quigley H, Urdaneta E, González A, La Parra D, Muntaner C, Alvarez-Dardet C, Martin-Moreno JM, McKee M. Erosion of universal health coverage in Spain. Lancet. 2013;382:1977.CrossRefPubMed
14.
Birch S, Eyles J, Newbold KB. Proxies for healthcare need among populations: validation of alternatives--a study in Quebec. J Epidemiol Community Health. 1996;50:564–9.CrossRefPubMedPubMedCentral
15.
Burström B, Fredlund P. Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Community Health. 2001;55:836–40.CrossRefPubMedPubMedCentral
16.
17.
18.
Gruber S, Kiesel M. Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation. J Public Health. 2010;18:351–65.CrossRef
19.
Kroll LK, Lampert T. Direct cost of inequalities in health care utilization in Germany 1994 to 2009: a top-down projection. BMC Health Service Research. 2013;13:271.CrossRef
20.
Giovanella L, Stegmüller K. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain. Cad Saude Publica. 2014;30:2263–81.CrossRefPubMed
21.
Geyer S, Peter R, Siegrist J. Socioeconomic differences in children’s and adolescents’ hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories. J Epidemiol Community Health. 2002;56:109–14.CrossRefPubMedPubMedCentral
22.
Regidor E, Martínez D, Calle ME, Astasio P, Ortega P, Domínguez V. Socioeconomic patterns in the use of public and private health services and equity in health care. BMC Health Serv Res. 2008;8:183.CrossRefPubMedPubMedCentral
23.
Regidor E, Martínez D, Astasio P, Ortega P, Calle ME, Domínguez V. Association of income with use of and access to health services in Spain at the beginning of the XXI century. Gac Sanit. 2006;20:352–9.CrossRefPubMed
24.
Urbanos R, Puig-Junoy J. Políticas de austeridad y cambios en las pautas de uso de los servicios sanitarios. Informe Sespas 2014. Gac Sanit. 2014;28(S1):81–8.CrossRef
25.
García-Subirats I, Vargas I, Sanz-Barbero B, Malmusi D, Ronda E, Ballesta M, Vazquez ML. Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis. Int J Environ Res Public Health. 2014;11:10182–201.CrossRefPubMedPubMedCentral
26.
27.
Metadata
Title
Use of health services according to income before and after elimination of copayment in Germany and restriction of universal health coverage in Spain
Authors
Lourdes Lostao
Siegfried Geyer
Romana Albaladejo
Almudena Moreno-Lostao
Elena Ronda
Enrique Regidor
Publication date
01-12-2018
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2018
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-018-0725-0

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