Inequalities in health care use among older adults in Sweden 1992-2011: a repeated cross-sectional study of Swedes aged 77 years and older.
OBJECTIVE
In the last decades, the Swedish health care system was reformed to promote free choice; however, it has been questioned whether older adults benefit from these reforms. It has also been proposed that reforms promoting free choice might increase inequalities in health care use. Thus, the aim of this study is to investigate socioeconomic differences in health care use among older adults in Sweden, from 1992 to 2011.


METHODS
The Swedish Panel Study of the Living Conditions of the Oldest Old (SWEOLD) is a nationally representative study of Swedes over 76 years old, including both institutionalized and community-dwelling persons. We analyzed cross-sectional data from SWEOLD waves in 1992, 2002 and 2011 (n ≈ 600/wave); and performed multivariate analyses to investigate whether socioeconomic position was associated with health care use (inpatient, outpatient and dental services) after need was accounted for.


RESULTS
For the period of 1992-2011, we found that higher education was associated with more use of outpatient and dental care, both before and after adjustment for need. The association between education and inpatient or outpatient care use did not change over time. There was an increase in the proportion of older adults whom used dental care over the 19-year period, and there was a tendency for the socioeconomic differences regarding dentist visits to decrease over time.


CONCLUSIONS
Our study covering 19 years showed relatively stable findings for socioeconomic differences in health care use among older adults in Sweden. We found there was a slight decrease in inequality in dental care; but unchanged socioeconomic differences in outpatient care, regardless of the changes that occurred in the Swedish health care system.
Aging Research Center, Karolinska Institutet, Stockholm University, Sweden jonas.wastesson@ki.se.
Jonas W
JW
Wastesson
Aging Research Center, Karolinska Institutet, Stockholm University, Sweden.
Stefan
S
Fors
Aging Research Center, Karolinska Institutet, Stockholm University, Sweden.
Marti G
MG
Parker
Aging Research Center, Karolinska Institutet, Stockholm University, Sweden.
Kristina
K
Johnell
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003729:Dental Care / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D012959:Socioeconomic Factors; D013548:Sweden
Ageing; Sweden; Swedish healthcare system; dental care; elderly; healthcare usage; inequality; inpatient; oldest old; outpatient; socioeconomic differences