Equity in the delivery of health care in Europe and the US

J Health Econ. 2000 Sep;19(5):553-83. doi: 10.1016/s0167-6296(00)00050-3.


This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Data Collection
  • Europe / epidemiology
  • Health Services / statistics & numerical data*
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand / statistics & numerical data*
  • Health Status Indicators*
  • Humans
  • Income
  • Medicine
  • Models, Econometric
  • Primary Health Care / statistics & numerical data
  • Social Justice*
  • Specialization
  • United States / epidemiology