© 1996 Oxford University Press
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Self-Perceived Health Status and Inequalities in Use of Health Services in Spain
* Seceión de Epidemiología, Delegación Provincial de Sanidad Subida de la Granja 10, 45071 Toledo, Spain.
Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine Keppel Street, London WC1E 7HT, UK.
BACKGROUND: Socioeconomic differences have been described among the Spanish population. The purpose of this study was to investigate whether these variations are associated with differences in the use of health services between socioeconomic groups in Spain, taking into account self-perceived health as a measure of need.
METHOD: Data were obtained from the 1987 Spanish National Health Survey. Socioeconomic position was measured by educational level and household income. Health care use was measured in two ways: prevalence of having consulted a doctor and of hospitalization over a defined period of time. Logistic regression models were used to analyse the relationships of interest.
RESULTS: After adjustment for age, an inverse association was seen between education and both consultation with a doctor and hospitalization. A very different picture emerged when the association between socioeconomic position and probability of health service use was examined according to level of self-perceived health. Among those with poor or very poor health, people in higher educational groups showed the greatest probability of consulting a doctor (adds ratio [OR]=1.41, 95% confidence interval [CI]: 0.89–2.23) or of being hospitalized (OR = 1.79, 95% Cl: 1.09–2.93) compared to those in the lower educational groups. The corresponding OR for household income were 1.02 (95% Cl: 0.74–1.42) for consultation with a doctor and 1.67 (95% CI: 1.15–2.44) for hospitalization. These findings were broadly similar for menand women.
CONCLUSIONS: There is a socioeconomic variation in the pattern of use of health services in Spain in the sense that among those with poor self-perceived health, the more privileged have higher levels of health services use than others.
Keywords health inequality, socioeconomic level, self-perceived health status, health services use
Revised 1 November 1995
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