SOCIOECONOMIC DIFFERENCES IN GENERAL-PRACTITIONER AND OUTPATIENT SPECIALIST CARE IN THE NETHERLANDS - A MATTER OF HEALTH-INSURANCE

Equal treatment for equal needs, irrespective of socio-economic positi on, is a major issue in many countries, Although in the Netherlands di fferences in utilization of health care between population groups are less pronounced than in most other countries, some differences by soci o-economic position do exist. Controlling for health status, individua ls with a high socio-economic status have a higher probability of outp atient contacts with a specialist, but a lower probability: of general practitioner contacts, compared with those with a low socioeconomic s tatus. In this cross-sectional. study, we studied whether socio-econom ic differences in GP and outpatient specialist care utilization that e xist after health status is taken into account could be explained by d ifferent aspects of health insurance. The study population, in which p eople with asthma and chronic obstructive pulmonary disease (COPD), di abetes mellitus, severe back complaints, and heart diseases are overre presented, consists of 2867 respondents. Multivariate analyses show th at the socio-economic differences in outpatient specialist contacts ca nnot be explained by differences in health insurance, whereas differen ces in general practitioner contacts can partially be explained by the fact that individuals with higher socio-economic status more often ha ve a private (instead of public) insurance. This is not owing to diffe rences in deductible or insurance coverage between public and private insurance, but is more likely to be caused by differences in regulator y aspects between these two insurance schemes (such as the stronger ga te-keeper role of the general practitioner in the public insurance sch eme). (C) 1997 Elsevier Science Ltd.