Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health?
BACKGROUND
Despite enormous public sector expenditures, the effectiveness of universal coverage for health care in reducing socioeconomic disparities in health has received little attention.


OBJECTIVE
s: To evaluate whether universal coverage for health care reduces socioeconomic disparities in health.


METHODS
Information on participants of the 1990 Nova Scotia Nutrition Survey was linked with eight years of administrative health services data and mortality. The authors first examined whether lower socioeconomic groups use more health services, as would be expected given their poorer health status. They then investigated to what extent differential use of health services modifies socioeconomic disparities in mortality. Finally, the authors evaluated health services use in the last years of life when health is poor regardless of a person's socioeconomic background.


METHODS
The Canadian province of Nova Scotia, which provides universal health care coverage to all residents.


METHODS
1816 non-institutionalised adults, aged 18-75 years, from a two stage cluster sample stratified by age, gender, and region.


RESULTS
People with lower socioeconomic background used comparatively more family physician and hospital services, in such a way as to ameliorate the socioeconomic differences in mortality. In contrast, specialist services were comparatively underused by people in lower socioeconomic groups. In the last three years of life, use of specialist services was significantly higher in the highest income group.


CONCLUSIONS
Universal coverage of family physician and hospital services ameliorate the socioeconomic differences in mortality. However, specialist services are underused in lower socioeconomic groups, bearing the potential to widen the socioeconomic gap in health.
Veugelers
P J
PJ
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada. paul.veugelers@dal.ca
Yip
A M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D009674:Nova Scotia; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000592:standards; D014600:Utilization Review