Is utilization of health services for HIV patients equal by socioeconomic status? Evidence from the Basque country.
BACKGROUND
Access to ART and health services is guaranteed under universal coverage to improve life expectancy and quality of life for HIV patients. However, it remains unknown whether patients of different socioeconomic background equally use different types of health services.


METHODS
We use one-year (2010-2011) data on individual healthcare utilization and expenditures for the total population (N = 2262698) of the Basque Country. We observe the prevalence of HIV and use OLS regressions to estimate the impact on health utilization of demographic, socioeconomic characteristics, and health status in such patients.


RESULTS
HIV prevalence per 1000 individuals is greater the lower the socioeconomic status (0.784 for highest; 2.135 for lowest), for males (1.616) versus females (0.729), and for middle-age groups (26-45 and 46-65). Health expenditures are 11826€ greater for HIV patients than for others, but with differences by socioeconomic group derived from a different mix of services utilization (total cost of 13058€ for poorest, 14960€ for richest). Controlling for health status and demographic variables, poor HIV patients consume more on pharmaceuticals; rich in specialists and hospital care. Therefore, there is inequity in health services utilization by socioeconomic groups.


CONCLUSIONS
Equity in health provision for HIV patients represents a challenge even if access to treatment is guaranteed. Lack of information in poorer individuals might lead to under-provision while richer individuals might demand over-provision. We recommend establishing accurate clinical guidelines with the appropriate mix of health provision by validated need for all socioeconomic groups; promoting educational programs so that patients demand the appropriate mix of services, and stimulating integrated care for HIV patients with multiple chronic conditions.
Departamento de Economía Aplicada II, Universidad Complutense de Madrid, Campus de Somosaguas, 28223 Pozuelo de Alarcón, Madrid, Spain. mggoni@ucm.es.
Manuel
M
García-Goñi
Deusto Business School, University of Deusto, Bilbao, Spain. roberto.nuno@deusto.es.
Roberto
R
Nuño-Solinís
Centro de Salud de Astrabudua, Osakidetza - Basque Health Service, Erandio, Spain. jon.oruetamendia@osakidetza.net.
Juan F
JF
Orueta
University of Murdoch, Perth, Australia. F.Paolucci@murdoch.edu.au.|University of Bologna, Bologna, Italy. F.Paolucci@murdoch.edu.au.
Francesco
F
Paolucci
D000328:Adult; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D019472:Universal Health Insurance / Q000706:statistics & numerical data