Measuring socioeconomic differences in use of health care services by wealth versus by income

Abstract

Objectives: We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator.

Methods: We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries.

Results: We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences.

Conclusions: We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.

FIGURE 1

Inequity in the probability of a doctor visit related to income and wealth in 12 countries: Health and Retirement Study, United States, 2004, and Survey of Health, Ageing, and Retirement in Europe, 2004. Note. Horizontal inequity in the probability of a visit to the doctor was significantly different from zero for socioeconomic status measured by wealth in Greece, income in Italy and Denmark, and both income and wealth in Germany, Sweden, and the United States (P < .05).

FIGURE 2

Inequity in the probability of a dentist visit by income and wealth in 12 countries: Health and Retirement Study, United States, 2004, and Survey of Health, Ageing, and Retirement in Europe, 2004. Note. All horizontal inequity indices were significantly different from zero at P < .05, except for socioeconomic status measured by income in the Netherlands.