An analysis of the role of health care in reducing socioeconomic inequalities in health: the case of the Netherlands.
The aim of this article is to analyze the role of the health care system in reducing socioeconomic inequalities in health in countries with good access to health services, using the Dutch example. In the past, health care has contributed substantially to reducing a number of health problems in the population, paticularly health problems leading to mortality. Data on trends in mortality from selected conditions by socioeconomic group show that both higher and lower socioeconomic groups have profited from these mortality reductions, probably because of largely equal access to essential health car services, and that absolute inequalities in mortality from these conditions have declined notably. The current situation is still one of largely equal financial access to health care services, with relatively small differences between socioeconomic groups in health care utilization, after adjustment for differences in prevalence of health problems. There is no evidence that inequalities in health care utilization contribute to a widening of socioeconomic inequalities in health. Financing of the health care system, however, is slightly regressive, and out-of-pocket payments contribute to the poor financial situation of the chronically ill. For the future, three possible contributions of the health care system to reducing socioeconomic inequalities in health are described: preservation of equal access to high-quality health care; development of specific care packages for lower socioeconomic groups; promotion and support of intersectoral activities.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. jmackenbach@erasmusmc.nl
Johan P
JP
Mackenbach
D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D012935:Social Justice; D012959:Socioeconomic Factors