Social class inequalities in the use of and access to health services in Catalonia, Spain: What is the influence of supplemental private health insurance?

Carme Borrell, Esteve Fernandez, Anna Schiaffino, Joan Benach, Luis Rajmil, Joan R. Villalbí, Andreu Segura

Research output: Contribution to journalArticle

Abstract

Objective. To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. Design. 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. Setting. Catalonia (Spain). Study participants. The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n=12 245). Main outcome measures. Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. Results. Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). Conclusion. The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

Original languageEnglish (US)
Pages (from-to)117-125
Number of pages9
JournalInternational Journal for Quality in Health Care
Volume13
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

private health insurance
Health Insurance
Social Class
Spain
social class
Health Services
health service
Health
health
National Health Programs
utilization
social inequality
Referral and Consultation
Catalonia
Health Surveys
health care services
Population
Health Status
hospitalization
health professionals

Keywords

  • Catalonia
  • Health services utilization
  • Inequalities in health
  • Preventive services
  • Social class
  • Spain
  • Waiting time

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Public Health, Environmental and Occupational Health

Cite this

Social class inequalities in the use of and access to health services in Catalonia, Spain : What is the influence of supplemental private health insurance? / Borrell, Carme; Fernandez, Esteve; Schiaffino, Anna; Benach, Joan; Rajmil, Luis; Villalbí, Joan R.; Segura, Andreu.

In: International Journal for Quality in Health Care, Vol. 13, No. 2, 2001, p. 117-125.

Research output: Contribution to journalArticle

Borrell, Carme ; Fernandez, Esteve ; Schiaffino, Anna ; Benach, Joan ; Rajmil, Luis ; Villalbí, Joan R. ; Segura, Andreu. / Social class inequalities in the use of and access to health services in Catalonia, Spain : What is the influence of supplemental private health insurance?. In: International Journal for Quality in Health Care. 2001 ; Vol. 13, No. 2. pp. 117-125.
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abstract = "Objective. To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. Design. 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. Setting. Catalonia (Spain). Study participants. The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n=12 245). Main outcome measures. Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. Results. Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50{\%} for classes I and II to 16{\%} for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). Conclusion. The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.",
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AB - Objective. To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. Design. 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. Setting. Catalonia (Spain). Study participants. The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n=12 245). Main outcome measures. Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. Results. Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). Conclusion. The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

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