Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?

Published: August 19, 2014
Category: Bibliography > Papers
Authors: Balicer RD, Davidovich N, Filc D, Novack L
Countries: Israel
Language: null
Types: Care Management
Settings: Health Plan, Hospital

Int J Equity Health 13:115.

Ben-Gurion University, Beer Sheva, Israel; Clalit Health Services, Tel Aviv, Israel

OBJECTIVES: To assess an association of Socio-economic status with utilization of health care services between years 2002 and 2008 in Israel.

METHODS: We retrospectively analyzed the utilization of health care services in a cohort of 100,000 members, 21 years and older, of a Clalit Health Services. The research compared utilization according to the neighborhood SES status; and clinic’s location as another SES proxy. Data included: Charlson Score morbidity factor, utilization of health care services (visits to primary physicians and specialists, purchase of pharmaceuticals, number of hospitalization days, visits to ED, utilization of laboratory tests and imaging). The analysis was performed using Generalized Linear Model (GLM) technique.

RESULTS: People with lower SES visited more the ED and primary physicians and were hospitalized for longer periods. People with higher SES visited more specialists, bought more prescription drugs and used more medical imaging. The associations between SES and most of the services we analyzed did not change between 2002 and 2008. However, the gap between lower and higher SES levels in ED visits and the use of prescription drugs slightly increased over time, while the gap in visits to specialists decreased.

CONCLUSIONS: The research shows that even in a universal health care system SES is associated with utilization of health care services. In order to improve equity in utilization of services the Israeli public health should reduce economic barriers and in parallel invest in making information accessible to improve “navigation skills” for all.

PMID: 25431139
PMCID: PMC4260253

Israel,Resource Use,Equity Evaluation,Population Markers,Acute Kidney Injury/diagnosis,Acute Kidney Injury/epidemiology,Age Factors,80 and over,Benzodiazepines/adverse effects,Cause of Death,Creatinine/blood,Dibenzothiazepines/adverse effects,Gender,Hospitalization/statistics & numerical data,Hypotension/chemically induced,Ontario/epidemiology,Quetiapine Fumarate,Retrospective Studies,Risk Factors,Risperidone/adverse effects,Urinary Retention/chemically induced

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