Equity in the delivery of health care in Europe and the US

This paper presents a comparison of horizontal equity in health care utiliz ation in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also us es new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences , there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a hig her use of GP care among lower-income groups. These findings appear to be f airly general and emerge in countries with very diverse characteristics reg arding access and provider incentives. (C) 2000 Elsevier Science B.V. All r ights reserved. JEL classification: 110.