Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey.
BACKGROUND
In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth.


METHODS
The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006-2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression.


RESULTS
We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women.


CONCLUSIONS
In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.
Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), MTFS, 7489, Trondheim, Norway. eirikv@stud.ntnu.no
Eirik
E
Vikum
Steinar
S
Krokstad
Steinar
S
Westin
D000328:Adult; D000367:Age Factors; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult