Equity and equality in the use of GP services for elderly people: the Spanish case

To present new evidence both on the horizontal inequity in the delivery of primary health care and on the factors driving inequalities in the use of GP services for Spanish population aged 50 years and over.

Cross-sectional study based on the Spanish sample of the Survey of Health, Aging and Retirement in Europe (SHARE) for 2006-07. We use the index proposed by Wagstaff and van Doorslaer (HI(WV)) to compute health care inequity. The concentration index measuring income related inequality in health care use is decomposed into the contribution of each determinant.

Our results show the presence of pro-poor inequality in both the access and the frequency of use for GP services, which is mainly explained by unequal distribution of need factors. The contribution of non-need factors to income related inequality is quite higher for the conditional number of GP visits (48.13%) than for the probability of positive use (17.55%). We have also found significant pro-poor inequity in the probability of access to a GP and in the conditional number of visits for elderly people.

The relevance of social determinants of health is confirmed, and hence the need for wide-scoped public policies to reduce health inequalities. At equal levels of need, rich and poor elderly people are not treated equally. As much as appropriateness of care provided is unknown, we cannot conclude that inequity in GP services really favours the lower income individuals in terms of health gains.