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Table 2 Results on relationships between socioeconomic status and utilization of primary-care and specialist physicians

From: Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review

author countries age group time physician utilisation SES measure need-adjusted result
Abasolo, Saez, López-Casasnovas [15] Spain ≥ 15 years 4 weeks primary care frequency household income ↓ o
specialist o
Agerholm et al. [16] Sweden 25 to 64 years 12 months primary care frequency adjusted household income ↑ o4
specialist +
65 to 84 years primary care o4
specialist +
Allin [17] Canada ≥ 15 years 12 months primary care probability adjusted household income ↑ +
frequency o
specialist probability +
frequency +
Asada, Kephart [18] Canada ≥ 20 years 12 months primary care probability education ↑ +
adjusted household income +
conditional frequency education –
adjusted household income –
specialist probability education +
adjusted household income +
conditional frequency education +
adjusted household income o
Bago d’Uva, Jones, van Doorslaer [19] Austria, Belgium, Denmark, Finland, Greece, Ireland, Italy, Netherlands, Portugal, Spain ≥ 16 years 12 months primary care frequency adjusted household income ↑ −5
specialist +
Baron-Epel, Garty, Green [20] Israel ≥ 21 years 4 weeks primary care probability education ↑ –
household income –
specialist education +
household income o
Beckman, Anell [21] Sweden 25 to 44 years 2 years primary care probability household income ↓ +
45 to 64 years o4
65 to 84 years +
Bergmann, Kalcklösch, Tiemann [22] Germany ≥ 18 years 12 months primary care frequency index ↑ –
Bourke [23] Ireland ≥ 16 years 12 months primary care probability adjusted household income ↑ o
frequency –
conditional frequency –
specialist probability +
frequency o
conditional frequency –
Bremer, Wübker [24] Germany ≥ 50 years 12 months primary care probability education ↑ o
adjusted household income o
conditional frequency education o
adjusted household income o
specialist probability education o
adjusted household income +
conditional frequency education o
adjusted household income +
Bremer, et al. [25] Pooled Data from 16 European Countries ≥ 50 years 12 months primary care frequency education ↑ –
Crespo-Cebada, Urbanos-Garrido [26] Spain ≥ 50 years 12 months primary care probability education ↑ o
adjusted household income o
conditional frequency education o
adjusted household income o
Devaux, de Looper [27] Austria, Belgium, Canada, Czech Republic, Denmark, Estonia, Finland, France, Hungary, Ireland, New Zealand, Poland, Slovak Republic, Slovenia, Spain, Switzerland, UK ≥ 15 years 12 months1 primary care probability adjusted household income ↑ o5
frequency o5
specialist probability + 5
frequency + 5
Fjaer, et al. [28] Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, Israel, Lithuania, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland, UK 25 to 75 years 12 months primary care probability education ↑ o5
specialist + 5
Garrido-Cumbrera, et al. [29] Spain ≥ 16 years 4 weeks primary care probability occupation ↑ –
specialist +
Glazier et al. [30] Canada 20 to 79 years 2 years primary care probability education ↑ o
adjusted household income o
conditional frequency education –
adjusted household income –
specialist probability education +
adjusted household income o
conditional frequency education +
adjusted household income o
Gonzalez-Alvarez, Barranquero [31] Spain ≥ 16 years 12 months primary care probability education ↑ –
adjusted household income o
frequency education –
adjusted household income o
conditional frequency education –
adjusted household income o
specialist probability education +
adjusted household income +
frequency education +
adjusted household income +
conditional frequency education o
adjusted household income o
Grasdal, Monstad [32] Norway 16 to 69 years 12 months primary care probability adjusted household income ↑ o
conditional frequency o
specialist probability + 6
conditional frequency o
Gruber, Kiesel [33] Germany 50 to 90 years 12 months specialist probability education ↑ o4
adjusted household income o4
frequency education o
adjusted household income o
Habicht, Kunst [34] Estonia 25 to 74 years 6 months primary care probability education ↑ o
adjusted household income +
specialist education +
adjusted household income +
Hansen, et al. [35] Norway 30 to 87 years 12 months primary care probability education ↑ o
household income o
occupation o
conditional frequency education o4
household income –
occupation o
Hoebel, et al. [12] Germany 18 to 69 years 12 months primary care probability index ↑ o
conditional frequency –
specialist probability +
conditional frequency o
Hoeck, et al. [36] Belgium ≥ 65 years 2 months primary care probability education ↑ o
adjusted household income o
specialist education o
adjusted household income o
Hoeck, et al. [37] Belgium ≥ 16 years 2 months primary care probability education ↑ o
adjusted household income o
conditional frequency education o
adjusted household income o
specialist probability education +
adjusted household income o
conditional frequency education o
adjusted household income o
≥ 65 years primary care probability education ↑ o
adjusted household income o
conditional frequency education o
adjusted household income o
specialist probability education +
adjusted household income o
conditional frequency education o
adjusted household income o
Korda, et al. [38] Australia 53 to 58 years 12 months primary care probability occupation ↑ o
conditional frequency o
specialist probability +
conditional frequency o
La Parra-Casado, et al. [39] Spain ≥ 16 years 4 weeks primary care probability occupation ↑ o
Lichte [40] Germany ≥ 18 years 3 months primary care conditional frequency education ↑ o
household income o
Lostao, et al. [41] UK ≥ 16 years 2 weeks2 primary care probability occupation ↑ o
specialist o
Spain primary care –
specialist +
Lu, et al. [42] Hong Kong ≥ 16 years 1 months primary care probability income ↑ +
frequency +
specialist probability o
frequency o
Masseria, Giannoni [43] Italy >  16 years 4 weeks primary care probability education ↑ –
adjusted household income +
specialist education +
adjusted household income o
McDonald, Conde [44] Canada 55 to 79 years 12 months primary care probability education ↑ +
adjusted household income +
conditional frequency education o
adjusted household income o
specialist probability education +
adjusted household income +
conditional frequency education +
adjusted household income o
Mosquera, et al. [45] Sweden 16 to 25 years 3 months primary care probability household income ↑ –
Nolan [46] Ireland ≥ 16 years 12 months primary care frequency education ↑ o
adjusted household income o
Palència, et al. [47] Spain ≥ 16 years 4 weeks primary care probability occupation ↑ –
specialist +
Põlluste, Kalda, Lember [48] Estonia 65 to 74 years 12 months primary care probability education ↑ o
adjusted household income o
specialist education o
adjusted household income o
Rattay et al. [49] Germany 18 to 79 years 12 months primary care probability index ↓ –
Regidor, et al. [50] Spain 16 to 74 years 2 weeks primary care probability education ↑ –
adjusted household income –
occupation –
specialist education +
adjusted household income +
occupation +
Reibling, Wendt [51] Austria, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, Switzerland ≥ 50 years 12 months specialist probability education ↑ + 5
Rogowski et al. [52] USA ≥ 65 years 12 months primary care frequency education ↑ o
adjusted household income o
specialist education +
adjusted household income o
Ryvicker, Gallo, Fahs [53] USA 60 to 99 years 12 months primary care probability education ↑ +
San Sebastian, Mosquera, Gustafsson [54] Sweden 18 to 84 years 3 months primary care probability income ↑ +
specialist o
Schnitzer, et al. [55] Germany 18 to 79 years 12 months specialist frequency education ↑ +
Schulz [56] Pooled Data from 13 European Countries ≥ 40 years 12 months primary care frequency education ↑ –
specialist +
Stirbu, et al. [11] Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, Netherlands, Norway ≥ 15 years 12 months3 primary care probability education ↑ o5
specialist +
Suominen-Taipale, et al. [57] Finland 65 to 74 years 12 months primary care probability education ↑ o
specialist +
Norway primary care +
specialist +
Tavares, Zantomio [58] Italy ≥ 50 years 12 months primary care frequency education ↑ –
specialist +
Spain primary care –
specialist +
Portugal primary care +
specialist +
Terraneo [10] Pooled Data from 12 European Countries ≥ 50 years 12 months primary care probability education ↑ o
specialist +
Thode et al. [59] Germany 18 to 79 years 12 months primary care frequency index ↑ –
Tille, et al. [60] Germany ≥ 18 years 12 months primary care frequency education ↑ –
specialist o
van Doorslaer, Koolman, Jones [61] Austria, Belgium, Denmark, Germany, Greece, Ireland, Italy, Luxemburg, Netherlands, Portugal, Spain, UK ≥ 16 years 12 months primary care probability adjusted household income ↑ o5
frequency −5
conditional frequency −5
specialist probability + 5
frequency + 5
conditional frequency o5
van Doorslaer, Masseria, Koolman [62] Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Netherlands, Norway, Portugal, Spain, Switzerland, UK ≥ 16 years 12 months primary care probability adjusted household income ↑ o5
conditional frequency −5
specialist probability +
conditional frequency + 5
van Ourti [63] Belgium >  15 years 12 months primary care frequency adjusted household income ↑ –
specialist o
Vasquez, Paraje, Estay [64] Chile ≥ 18 years 3 months primary care probability adjusted household income ↑ +
frequency +
specialist probability +
frequency +
Vedsted et al. [65] Denmark 20 to 34 years 12 months primary care conditional frequency education ↑ o
35 to 49 years o
50 to 64 years o4
Vedsted, Olesen [66] Denmark 20 to 64 years 12 months primary care conditional frequency education ↑ o4
Vikum, et al. [67] Norway ≥ 20 years 12 months primary care probability education ↑ o4
20 to 67 years income o4
≥ 20 years specialist education +
20 to 67 years income +
Vikum, Krokstad, Westin [68] Norway ≥ 20 years 12 months primary care probability education ↑ –
adjusted household income o
specialist education +
adjusted household income +
  1. 1, deviating for probability in Denmark: 3 months; and for frequency in some EHIS countries: 4 weeks
  2. 2, deviating for outpatient consultations in UK: 3 months
  3. 3, deviating for consultations in Netherlands and Belgium: 2 months
  4. 4, significant results only in gender-specific subgroup-analyses
  5. 5, results differ for several countries, only the most frequent results are reported
  6. 6, only for private specialists; results for hospital outpatient visits are non-significant
  7. +, higher utilization in the most advantaged; o, no significant differences; -, higher utilization in the most deprived
  8. ↑, adjustment for at least gender, age and any general health variable (e.g., self-rated health or chronic conditions); ↓, relevant adjustments for need have not been conducted
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International Journal for Equity in Health

ISSN: 1475-9276

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