Health Policy
Vol: 67, Issue: 3, March, 2004

Inequities in access to medical care in five countries: findings from the
2001 Commonwealth Fund International Health Policy Survey
Authors:  Schoen, Cathya; Doty, Michelle M.a
Affiliations:  a. Health Policy, Research and Evaluation, The Commonwealth
Fund, One East 75th Street, New York, NY 10021, USA
Keywords:  Health; Policy; International; Inequality; Access; Insurance
Abstract (English):  Objective: To examine across five countries inequities
in access to health care and quality of care experiences associated with
income, and to determine whether these inequities persist after controlling
for the effect of insurance coverage, minority and immigration status,
health and other important co-factors. Design: Multivariate analysis of a
cross-sectional 2001 random survey of 1400 adults in five countries:
Australia, Canada, New Zealand, United Kingdom, and United States. Main
outcome measures: Access difficulties and waiting times, cost-related
access problems, and ratings of physicians and quality of care. Results:
The study finds wide and significant disparities in access and care
experience between US adults with above and below-average incomes that
persist after controlling for insurance coverage, race/ethnicity,
immigration status, and other important factors. In contrast, differences
in UK by income were rare. There were also few significant access
differences by income in
Australia; yet, compared to UK, Australians were more likely to report out
of pocket costs. New Zealand and Canada results fell in the mid-range of
the five nations, with income gaps most pronounced on services less well
covered by national systems. In the four countries with universal coverage,
adults with above-average income were more likely to have private
supplemental insurance. Having private insurance in Australia, Canada, and
New Zealand protects adults from cost-related access problems. In contrast,
in UK having supplemental coverage makes little significant difference for
access measures. Being uninsured in US has significant negative
consequences for access and quality ratings. Conclusions: For policy
leaders, the five-nation survey demonstrates that some health systems are
better able to minimize among low income adults financial barriers to
access and quality care. However, the reliance on private coverage to
supplement public coverage in Australia, Canada, and New Zealand can result
in access in
equities even within health systems that provide basic health coverage for
all. If private insurance can circumvent queues or waiting times, low
income adults may also be at higher risks for non-financial barriers since
they are less likely to have supplemental coverage. Furthermore, greater
inequality in care experiences by income is associated with more divided
public views of the need for system reform. This finding was particularly
striking in Canada where an increased incidence of disparities by income in
2001 compared to a 1998 survey was associated with diverging views in 2001.

Publisher:  Elsevier Science

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