PRIVATE MEDICINE AND SOCIOECONOMIC DIFFERENCES IN THE RATES OF COMMONSURGICAL-PROCEDURES IN FINLAND

The aim of the study was to evaluate socioeconomic equity in access to surgical services in Finland and to explore the contribution of priva te sector procedures to any inequities. Data on nine common surgical p rocedures performed on patients aged 25 and over were obtained from th e 1987-88 Finnish Hospital Discharge Register. Socioeconomic indicator s were linked to the procedure data by personal identity numbers from the 1987 population census, which was also used to derive the data on population at risk. The study revealed marked differences in rates acr oss socioeconomic categories for several procedures. Some of these dis parities are probably explained by variations in need for surgery acro ss socioeconomic groups. However, for cataract operations and hip repl acements due to arthrosis or deformity, the surgery rates favoured the better-off, despite low social status being considered a risk factor for these disorders. The correlation of disposable family income with hysterectomy and prostatectomy rates, and the low surgery rates for ma ny procedures in the lowest income quintile also suggested socioeconom ic disparities in access to services. The specific effect of private s ervices is difficult to assess, but the private sector seems to have c ontributed to the socioeconomic differences in rates for, at least, hy sterectomy, prostatectomy, and cataract operations. Although the Finni sh health care system operates universal coverage without formal barri ers to equal access, systematic socioeconomic inequity in the use of i ndividual surgical treatments prevail. Part of these inequities is evi dently due to private sector services.