Economic Class and Differential Access to Care: Comparisons among Health Care Systems

Abstract

This paper presents a new technique for describing inequality of access to medical care. Access is described by the empirical relationship between need and the probability of entering the health care system for treatment. The need-entry probability relationship for one population group is compared with that for another population group to determine the extent of access differentials (differences in entry probabilities) at varying levels of need. As an illustrative application, the technique is employed to describe access differentials by economic class in six different geographic areas located in five different countries (Canada, England, Finland, Poland, United States) with differently structured health care systems. Although the findings for adults varied considerably from area to area, the access differentials among children were surprisingly consistent and unrelated to health care system structure. In particular, it appears that higher family income is associated with greater access to medical care among children at all levels of need. The paper concludes with suggestions for further applications of the proposed technique to problems of monitoring and evaluating the effectiveness of policies aimed at reducing the extent of access inequality.

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References

Donabedian

Social responsibility for personal health services: An examination of basic values. Inquiry 8(2): 3–19, 1971.

Anderson

Health Care: Can There Be Equity? John Wiley & Sons, New York, 1972.

Beck

R. G.

Economic class and access to physician services under public medical care insurance. Int. J. Health Serv. 3(3): 341–355, 1973.

Gish

Resource allocation, equality of access, and health. Int. J. Health Serv. 3(3): 399–412, 1973.

Kohn

White

, editors. Health Care: An International Study. Oxford University Press, London, in press.

Aday

Andersen

Anderson

Fleming

Taylor

Development of a Framework for the Study of Access to Health Care: Preliminary Report Number 1. Center for Health Administration Studies, University of Chicago, 1973 (mimeographed).

Aday

Andersen

Anderson

Fleming

Mirabito

Taylor

Development of Indices of Access to Medical Care. Center for Health Administration Studies, University of Chicago, 1974 (mimeographed).

Last

J. M.

The iceberg: “Completing the clinical picture” in general practice. Lancet 2: 28–31, 1963.

Davis

Financing Medical Care: Implications for Access to Primary Care. Paper presented to the Sun Valley Forum on National Health, Sun Valley, Idaho, June 28, 1973.

10.

Donabedian

Models for organizing the delivery of personal health services and criteria for evaluating them. Milbank Mem. Fund Q. 50(4, part 2): 103–154, 1972.

11.

Mushlin

Accessibility to Medical Care in a Health Maintenance Organization. Health Services Research and Development Center, Johns Hopkins University, 1974 (mimeographed).

12.

Cochrane

Effectiveness and Efficiency. Nuffield Provincial Hospitals Trust, London, 1972.

13.

Lampman

Notes on Equity and Health Care. Research Report 12. Health Economics Research Center, University of Wisconsin, 1971 (mimeographed).

14.

Bice

Medical Care for the Disadvantaged. Department of Medical Care and Hospitals, Johns Hopkins University, 1971 (mimeographed).

15.

Gunderson

Statistical Models for Dichotomous Dependent Variables. Working Paper 72-15. Center for Industrial Relations, University of Toronto, 1972 (mimeographed).

16.

Williams

Need as a Demand Concept. Department of Economics, University of York, York, England, undated (mimeographed).