[Socioeconomic differences in the use and accessibility of health care services in Spain]

One of the main goals of the public health care systems is to assure an equitable accessibility and utilization of health care services according to the need for care. The present study evaluates the extent to which this objective has been reached in the Spanish National Health System from the socioeconomic perspective. POBLATION AND METHOD: The 1993 National Health Survey was used. Doctor consultation, use of inpatient hospital services, dentist consultation and gynaecologist consultation were the indicators of utilization analysed. Accessibility was measured by time spent travelling to the health centre, time spent waiting at health centre and time spent waiting for an ordinary admission to hospital. Educational level was the socioeconomic variable used.

Doctor consultation and use of inpatient hospital services were more frequent in individuals with the lowest level of education, while dentist and gynaecologist consultation were in those with the highest level. No statistically significant differences were observed in doctor consultation and use of inpatient hospital services after adjusting for age, sex, health care coverage and several need indicators by using a multiple logistic regression model. On the contrary, the odds ratios for individuals with first, second and third educational level were 1.31 (CI 95% = 1.14-1.51), 1.74 (1.49-2.03) and 2.06 (1.71-2.47) in dentist consultation and 2.01 (1.71-2.35), 2.40 (2.01-2.87) and 2.54 (2.02-3.21) in gynaecologist consultation. On the other hand, individuals with no education showed the longest average waiting times, especially for an ordinary admission to hospital, which was 83.5 days for subjects with no education and 18.8 for those with third educational level. However, the multiple linear regression analysis only found statistically significant results in time spent travelling to the health center and time spent waiting at the health center.

Although no differences in doctor consultation and use of inpatient hospital services by socioeconomic status were found, the results obtained regarding the use of other health care services and waiting times indicate the persistence of barriers limiting the equitable access and utilization of health care services in Spain.