Evidence map›Paper›PMID 16415462›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2006

Inequalities in access to medical care by income in developed countries.

Eddy van Doorslaer, Cristina Masseria, Xander Koolman, OECD Health Equity Research Group

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 306 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
306citing papers in PubMed, 6 pooled it
60.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

306 citing papers in PubMed, 6 syntheses or guidelines pooled it, 953 citations in OpenAlex.

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246 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Eddy van DoorslaerDepartment of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, Netherlands. e.vandoorslaer@erasmusmc.nl
Cristina Masseria
Xander Koolman
OECD Health Equity Research Group
Erasmus University Rotterdam · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMost of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000.

methodsUsing data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use.

resultsWe found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland.

interpretationAlthough in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.

Indexed as

Health Services AccessibilityIncomeAdolescentAdultAgedAge FactorsEuropeFemaleHealth Care SurveysHumansMaleMiddle AgedPhysicians, FamilySex Factors

Identifiers

PMID16415462
PMCPMC1329455
OpenAlexW2129490367

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.