title: Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Politics and Government, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel. dfilc@bgu.ac.il.
authors.forename: Dani
authors.initials: D
authors.lastname: Filc
authors.affiliation: Department of Health Systems Management, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel. nadavd@bgu.ac.il.
authors.forename: Nadav
authors.initials: N
authors.lastname: Davidovich
authors.affiliation: Department of Public Health, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel. novack@bgu.ac.il.
authors.forename: Lena
authors.initials: L
authors.lastname: Novack
authors.affiliation: Clalit Research Institute, Chief Physician Office, Clalit Health Services, Arlozorov 101, Tel Aviv, Israel. rbalicer@clalit.org.il.
authors.forename: Ran D
authors.initials: RD
authors.lastname: Balicer
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018855:Single-Payer System; D012923:Social Class; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*