Abstract
BackgroundIn Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country.MethodsData were taken from the 2009 and 2014 Socio-Economic Panel conducted in Germany, and from the 2009 and 2014 European Health Surveys in Spain. The health services investigated were physician consultations and hospital admissions, and the measure of socioeconomic position used was household income. The magnitude of the relationship between socioeconomic position and the use of each health service in people from 16 to 74 years old was estimated by calculating the percentage ratio using binary regression.ResultsIn Germany, after adjusting for age, sex, and need for care, in the model comparing the two lower income categories to the two higher categories, the percentage ratio for physician consultation was 0.97 (95% CI 0.96–0.99) in 2009 and 0.98 (95% CI 0.97–0.99) in 2014, and the percentage ratio for hospitalization was 1.01 (95% CI 0.93–1.10) in 2009 and 1.16 (95% CI 1.08–1.25) in 2014. In Spain, after adjusting for age, sex, and self-rated health, the percentage ratio for physician consultation was 0.99 (95% CI 0.94–1.05) in 2009 and 1.08 (95% CI 1.03–1.14) in 2014, and the percentage ratio for hospitalization was 1.04 (95% CI 0.92–1.18) in 2009 and 0.99 (95% CI 0.87–1.14) in 2014.ConclusionThe results suggest that elimination of the copayment in Germany did not change the frequency of physician consultations, whereas after the restriction of universal health coverage in Spain, subjects with lower incomes had a higher frequency of physician consultations.
Highlights
In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012
In 2012 Spain implemented a measure that restricted the use of public health services, both for Spaniards who were not affiliated with the Social Security and had an annual income of over 100,000 euros, and for immigrants who did not belong to the Social Security system [11,12,13]
In Germany, the percentage ratio adjusted for age and sex showed no significant differences in any of the income categories with respect to the highest category
Summary
In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country. The economic crisis of 2008 may have had an impact on one of the basic principles underlying the Welfare State, which is equality in the use of health services for the same level of need. In 2012 Spain implemented a measure that restricted the use of public health services, both for Spaniards who were not affiliated with the Social Security and had an annual income of over 100,000 euros, and for immigrants who did not belong to the Social Security system [11,12,13]. Other restrictive measures were the increase of the copayment in medicines according to the level of income, which in the case of people with annual income equal to or greater than 100,000 euros reached 60% of the retail price
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