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AJPH First Look, published online ahead of print Jan 15, 2009
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October 2009, Vol 99, No. 10 | American Journal of Public Health 1849-1855
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.141499

RESEARCH AND PRACTICE

Measuring Socioeconomic Differences in Use of Health Care Services by Wealth Versus by Income

Sara Allin, PhD, Cristina Masseria, PhD and Elias Mossialos, MD, PhD

At the time of the study, Sara Allin was with LSE Health, London School of Economics and Political Science, London, England. Cristina Masseria and Elias Mossialos are with LSE Health, London School of Economics and Political Science, London, England. Elias Mossialos is also with the European Observatory on Health Systems and Policies, London.

Correspondence: Correspondence should be sent to Elias Mossialos LSE Health, Cowdray House, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England (e-mail: e.a.mossialos{at}lse.ac.uk). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator.

Methods. We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries.

Results. We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences.

Conclusions. We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.






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