Socioeconomic differences in the utilization of health services in a Dutch population: the contribution of health status

The main question addressed here is to what extent socioeconomic differences in the utilization of health services in the Netherlands can be explained by health status. Our aim is to assess whether the health service has achieved equal access for equal needs, and which health status measures best control for need. Cross-sectional survey data from 2867 respondents with respect to utilization of six different types of health service are used for analysis. Socioeconomic differences in utilization were present for all services after we controlled for age, sex and marital status. By controlling for health status, differences changed markedly for all health services analyzed. Differences in general practitioner contacts diminished but did not disappear (adjusted odds ratio primary education/university 2.22). The pattern of excess contacts with specialist physicians reverses (adjusted odds ratio 0.74). This is also true for the physiotherapist. The pattern of hospitalizations is unclear. Use of over-the-counter medicines is little affected by control for health status. Adjusted differences in use of prescription medicines become small. Control for health status is best achieved with a set of health measures covering several dimensions of health. Whether low relative utilization among those with low education reflects limited access, or whether higher use of other services is compensatory is hard to decide on the basis of this study. Monitoring access to health care is important for all sorts of systems, including those which are believed to be equitable.