SOCIOECONOMIC INEQUITY IN HEALTH-CARE - A STUDY OF SERVICES UTILIZATION IN CURACAO

The aim of this study is to examine whether there is socioeconomic equ ity in health care utilization in Curacao, Netherlands Antilles. We ex plore how educational level is related to utilization of GPs, speciali sts, hospitals, dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examin es whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of c ontacts. The data were derived from the Curacao Health Study, a health interview survey among a random sample (N = 2248) of the non-institut ionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilizati on in Curacao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediati ng effects of socioeconomic inequalities in health (need) are taken in to account, but also before adjustment for health inequalities. In oth er words: there appears to be both vertical inequity (i.e. greater nee ds for services ate not met by greater use) and horizontal inequity (i .e. similar needs for care are not met by similar levels of services u se). The observed inequalities in use of specialists and hospitals con trast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental s ervices are used more extensively by higher educated individuals. (C) 1997 Elsevier Science Ltd.