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Socioeconomic differences in children's use of physician services in the Nordic countries
M Halldórsson1, A E Kunst, L Köhler
1Directorate of Health in Iceland Department of Public Health, Erasmus University, Rotterdam, the Netherlands. matthias@landlaeknir.is
Insights
Socioeconomic factors, particularly maternal education, influence children's healthcare access in Nordic countries. Specialist and telephone services showed inequalities, unlike GP and hospital care.
Area of Science:
- Healthcare access research
- Pediatric health services utilization
- Socioeconomic determinants of health
Background:
- Socioeconomic status (SES) is a known determinant of health outcomes and healthcare utilization.
- Understanding disparities in physician service use among children is crucial for equitable healthcare delivery.
- Previous research indicates variations in healthcare access based on socioeconomic factors, but specific patterns for pediatric services require further investigation.
Purpose of the Study:
- To examine the relationship between socioeconomic factors and the utilization of physician services among children in Nordic countries.
- To investigate whether co-payment variations correlate with inequalities in health service use.
- To identify specific socioeconomic determinants influencing children's access to different types of healthcare services.
Main Methods:
- Cross-sectional study utilizing countrywide postal surveys in five Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) in 1996.
- Sample included 15,000 children aged 2-17 years, randomly selected from national registries.
- Analysis involved calculating odds ratios for the use of general practitioner (GP), specialist, and hospital services based on parental education and family income, adjusted for age, sex, urbanization, and health status.
Main Results:
- Minimal socioeconomic differences were observed in general practitioner (GP) service use.
- Lower socioeconomic groups utilized physician telephone services less and were seen less by specialists.
- Children from lower socioeconomic backgrounds had higher rates of hospitalization, with disparities more pronounced in Denmark, Finland, and Norway. Maternal education emerged as a stronger predictor than income.
- Differential use of specialist and telephone services was more evident than for GP and hospital services.
Conclusions:
- Healthcare access for specialist and telephone services among children in the Nordic countries does not fully meet the principle of equal use for equal need.
- General practitioner (GP) and hospital services demonstrated a greater degree of equitable utilization.
- Maternal education was identified as a more significant determinant of healthcare service use for children than family income.
Objective:
To assess the relation between socioeconomic factors and the use of physician services among children and whether variations of the level of co-payment are correlated with different levels of inequalities in health services use.
Design:
Description of the socioeconomic differences in the use of health care using data from countrywide postal surveys to parents.
Setting:
The five Nordic countries in 1996.
Subjects:
Samples of 15 000 children aged 2-17 years: 3000 children at random, from the national registry in each country.
Main Outcome Measure:
Odds ratios of use of GP, specialist, and hospital services between children according to the educational level of both parents and the disposable income of the family, for all countries together and for each country separately. Odds ratios were adjusted for age, sex, urbanisation grade, and health status.
Results:
There was little difference in the use of GP services according to socioeconomic factors. Parents from lower socioeconomic groups used telephone services of physicians less than parents from the higher groups and children of lower socioeconomic groups were seen less often by specialists. The reverse was true for hospitalisation of the children. The differential use of those three types of services was more marked in Denmark, Finland and Norway than in Iceland and Sweden. When controlled for other socioeconomic factors, the largest differences were observed according to the education of the mother.
Conclusion:
The specialist services and use of telephone services for children in the Nordic countries do not meet the criteria of equal use for equal need whereas the GP services and hospital services do to some extent. The education of the mother is a more important determinant than income for the use of each service.
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