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Veugelers PJ, Yip AM. Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health?

Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.
Journal of Epidemiology &amp Community Health (Impact Factor: 3.29). 07/2003; 57(6):424-8. DOI: 10.1136/jech.57.6.424
Source: PubMed

ABSTRACT Despite enormous public sector expenditures, the effectiveness of universal coverage for health care in reducing socioeconomic disparities in health has received little attention.
s: To evaluate whether universal coverage for health care reduces socioeconomic disparities in health.
Information on participants of the 1990 Nova Scotia Nutrition Survey was linked with eight years of administrative health services data and mortality. The authors first examined whether lower socioeconomic groups use more health services, as would be expected given their poorer health status. They then investigated to what extent differential use of health services modifies socioeconomic disparities in mortality. Finally, the authors evaluated health services use in the last years of life when health is poor regardless of a person's socioeconomic background.
The Canadian province of Nova Scotia, which provides universal health care coverage to all residents.
1816 non-institutionalised adults, aged 18-75 years, from a two stage cluster sample stratified by age, gender, and region. Main results: People with lower socioeconomic background used comparatively more family physician and hospital services, in such a way as to ameliorate the socioeconomic differences in mortality. In contrast, specialist services were comparatively underused by people in lower socioeconomic groups. In the last three years of life, use of specialist services was significantly higher in the highest income group.
Universal coverage of family physician and hospital services ameliorate the socioeconomic differences in mortality. However, specialist services are underused in lower socioeconomic groups, bearing the potential to widen the socioeconomic gap in health.

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    • "It is undeniable that health care, especially when provided universally, promotes equality. With the introduction of universal care, for instance, disparities in service utilization and access across socioeconomic classes tend to decrease [37] [38], although the health status gradient never completely disappears [39] [40]. Furthermore, UHC coverage implies a sense of solidarity and interconnectedness within a society as members agree to pool resources to guarantee at least an acceptable level of response to those in need. "
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    ABSTRACT: The sustainability of health care systems, particularly those supporting universal health care, is a matter of current discussion among policymakers and scholars. In this article, we summarize the controversies around the economic sustainability of health care. We attempt to extend the debate by including a more comprehensive conceptualization of sustainability in relation to health care systems and by examining the dimensions of social and political sustainability. In conclusion, we argue that policymakers when taking decisions around universal health care should carefully consider issues of social, political, and economic sustainability, their interaction, and often their inherent trade-offs.
    Value in Health 02/2013; 16(1 Suppl):S34-8. DOI:10.1016/j.jval.2012.10.006 · 2.89 Impact Factor
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    • "En Grande-Bretagne, une e ´tude menée par Hippisley-Cox et Pringle (2000) montre que les territoires défavorisés ont un faible accès a ` l'angiographie coronaire et a ` la revascularisation [7]. Avec la création de l'assurance-santé universelle, on devrait s'attendre a ` une e ´galité d'accès et d'utilisation des services de santé au Canada [8]. Cependant, ceci est loin d'e ˆtre le cas tant a ` l'e ´chelle nationale qu'a ` l'intérieur des provinces [9] [10] [11]. "
    Revue d Épidémiologie et de Santé Publique 01/2012; · 0.66 Impact Factor
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    • "The UCS has also reduced the catastrophic and impoverishing burden of hospital admission on lower income households (Somkotra and Lagrada 2009). However, other studies have indicated that socioeconomic inequalities still persist, despite universal coverage being achieved (Lu and Hsiao 2003; Veugelers and Yip 2003; Schoen and Doty 2004; Suraratdecha et al. 2005; Yiengprugsawan et al. 2007). "
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    ABSTRACT: Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required.
    Health Policy and Planning 03/2011; 26(2):105-14. DOI:10.1093/heapol/czq028 · 2.65 Impact Factor
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