Assessing inequalities in preventive care use in Europe: A special case of health-care inequalities?

This paper presents the first cross-country estimation of needs-adjusted income and education-related inequalities in the use of a whole set of preventive care treatments. Analysis is based on the last three waves of the Survey of Health, Ageing and Retirement (SHARE) for individuals aged 50 and over living in 13 European countries. We employ alternative concentration indices based on the CI-corrections for binary outcomes to compute inequalities in the use of breast cancer screening, of colorectal cancer screening, of influenza vaccination, and of routine prevention tests, such as blood pressure, cholesterol, and blood sugar tests. After controlling for needs, we find that in many European countries strong pro-rich and educational inequalities exist with respect to breast cancer screening, cholesterol and blood sugar tests. Furthermore, we find that poor and less educated people are more likely than the better off to use preventive care late, e.g. when health shocks occurred or health problems display already symptoms. Finally, results suggest that access to treatments within a specialist setting is generally less equal than access to treatments provided within a GP setting. Equity implications of the results are then discussed according to different possible theories of distributive justice in health care delivery.