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Session: Income-Related Health Inequality
Room: Elissa Hall
Time: Fri 16:00-17:15

Presenter: Janek Saluse (University of Tartu. Department of Public Health)

Abstract

Aim
The study assesses the income-related equity and inequality of health care utilisation in Estonia, a typical Eastern European country with high income inequality and high share of out-of-pocket payments in total health expenditures (one fifth in Estonia). This is one of the few attempts in assessing income-related equity and equality in the utilisation of health care in Eastern Europe using internationally comparative approach.

Methods
We use the methods outlined in Van Doorslaer, Masseria et al (2004), a major study on OECD countries. Income-related inequality in health care utilisation is measured with the concentration index (CI) and horizontal inequity is measured with the horizontal inequity index (HI) derived from CI after standardizing the need for health care. The income-related inequality is further decomposed into socio-economic determinants using a regression-based approach.

Data
The study uses micro level data from the Estonian Household Budget Survey 2006, which included a separate section on health status and health care utilisation in that year. Self-reported number of contacts with health service providers during last six months is used. We differentiate between visits to family doctor, dentist and other medical specialist, phone consultation, use of emergency medical care, day treatment and hospitalization. Need for health care is approximated with age, gender, self-reported health status and self-reported disability status. In total data on 7,826 individuals in 3,628 households were used.

Results
The results show negative income-related inequality for visits to family doctor, utilisation of emergency medical care and hospitalisation. After standardisation for health care need, these effects disappear and the utilisation of dental care, phone consultations and day treatment service turn out to be positively related to income.

Conclusions
In general, the results on Estonia are comparable to the results of OECD countries. The problematic areas of inequity are in the utilisation of dental care, phone consultations and day treatment service where the wealthier population has an advantage. The Estonian results imply that health care financing affects significantly the inequity in health care utilisation. Dental care for adults is not covered by the health insurance in Estonia and day treatment with high out-of-pocket payments is often used because of long queues in health insurance system.

Key Terms

income-related inequality, health care utilisation, Estonia

Authors:

Janek Saluse (University of Tartu. Department of Public Health) and Andres Võrk (University of Tartu. Institute of Economics)

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