SOCIOECONOMIC DIFFERENCES IN THE USE AND ACCESSIBILITY OF HEALTH-CARESERVICES IN SPAIN

BACKGROUND: One of the main goals of the public health care systems is to assure an equitable accessibility and utilization of health care s ervices according to the need for care. The present study evaluates th e extent to which this objective has been reached in the Spanish Natio nal Health System from the socioeconomic perspective. POBLATION AND ME THOD: The 1993 National Health Survey was used. Doctor consultation, u se of inpatient hospital services, dentist consultation and gynaecolog ist consultation were the indicators of utilization analysed. Accessib ility was measured by time spent travelling to the health centre, time spent waiting at health centre and time spent waiting for an ordinary admission to hospital, Educational level was the socioeconomic variab le used. RESULTS: Doctor consultation and use of inpatient hospital se rvices were more frequent in individuals with the lowest level of educ ation, while dentist and gynaecologist consultation were in those with the highest level. No statistically significant differences were obse rved in doctor consultation and use of inpatient hospital services aft er adjusting for age, sex, health care coverage and several need indic ators by using a multiple logistic regression model. On the contrary, the odds ratios for individuals with first, second and third education al level were 1.31 (CI 95% = 1.14-1.51), 1.74 (1.49-2.03) and 2.06 (1. 71-2.47) in dentist consultation and 2.01 (1.71-2.35), 2.40 (2.01-2.87 ) and 2.54 (2.02-3.21) in gynaecologist consultation. On the other han d, individuals with no education showed the longest average waiting ti mes, especially for an ordinary admission to hospital, which was 83.5 days for subjects with no education and 18.8 for those with third educ ational level. However, the multiple linear regression analysis only f ound statistically significant results in time spent travelling to the health center and time spent waiting at the health center.Conclusions : Although no differences in doctor consultation and use of inpatient hospital services by socioeconomic status were found, the results obta ined regarding the use of other health care services and waiting times indicate the persistence of barriers limiting the equitable access an d utilization of health care services in Spain.