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There are large differences across OECD countries in average doctor consultation behaviour, however due to service distribution tending to favour low income groups we see more utilisation from this group. When need-standardised distributions are considered, better off groups are favoured (in terms of contact probability and total number of visits). The highest amount of pro-rich inequity in doctor use is in the US and Mexico (two countries without universal coverage).

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Most of the member countries of the OECD aim to ensure equitable access to health care --> access to good quality service is reduced to almost zero

due to a variety of public insurances

available on the basis of need and not willingness or ability to pay

examines equity in physician utilization in 21 OECD countries for the year 2000

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In most countries GP visits are equitably distributed across income groups, any significant inequity is often pro-poor. Only country that was pro-rich GP distribution is Finland.

In all countries the rich are significantly more likely to see a specialist than the poor and more frequently. Most steep pro-rich inequity is seen in Portugal, Finland, Ireland and Italy.

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the likelihood of seeing a GP appears to be distributed according to need, and is

not much influenced by income

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there is significant pro-rich inequity in the likelihood of contacting a specialist

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Between-country differences in mean physician consultation fractions and frequencies

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Between-country differences in mean physician consultation fractions and frequencies

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Over 70% on average seeking medical care in most nations.

Notably lower rates are observed in Greece, the United States, and particularly Mexico.

High-use countries like Germany and France averaging 7–8 visits per year, contrasting with low-use countries like Finland and the United States.

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The distributions of visits to a medical specialist are significantly in favour of the higher-income groups.

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Limitations: the survey data does not allow to go beyond comparisons of reported quantities of use to examine differences in quality of care.

In countries where private HS services are offered alongside public HS, not all doctor visits can be assumed to be of the same quality.

"Needs" adjustment is needed to look into to improve current estimates of inequity.

This could be achieved focusing attention on subpopulations eg chronically ill patients, but would mean losing the system-wide perspective.

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These discrepancies in health care usage translate into inequalities and differential health outcomes, therefore it is policy-relevant and income-related patterns of health care should be considered.

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a logical yardstick for international comparisons is the degree of inequality in use by income that remains after standardization for need differences

standardized questionnaire and involves annual interviewing of a representative panel of households and people 16 years and older in each European Union member state

health care utilization was based on the following question: “During the past 12 months, about how

many times have you consulted a general practitioner or a medical specialist?”

To measure the degree of inequity in health care they compared the actual observed distribution of medical care by income with the need-expected distribution of use

degree of inequality in health care utilization was measured using the concept of a concentration curve

Visits were standardized for need differences using age, sex and reported health levels as proxies

inequity in doctor utilization was measured by income using concentration indices of the need-standardized use