Swedish study finds growing income inequities in the utilization of health care resources

Swedish people with the lowest incomes utilize primary and outpatient care on par with those with the highest incomes despite having significantly higher mortality rates, according to a new study published November 16 in the open access journal PLOS Medicine by Pär Flodin of Karolinska Institutet, Sweden, and colleagues.

Socioeconomic differences in health care utilization have persisted in modern welfare states even with universal health care. In recent decades, Sweden has witnessed a rise in income inequalities, accompanied by shifts in the sociodemographic composition of the population and transformations of the health care system.

In the new study, researchers linked data on income and sociodemographic to data on utilization of primary, outpatient, and inpatient care, as well as to mortality for all Swedish individuals over the age of 16 from 2004 through 2017.

For all years of the study, people in the lowest income quantile utilized marginally more primary care (OR 1.07, 95% CI 1.07-1.08, p< 0.001) and specialized outpatient care (OR 1.04, 95% CI 1.04-1.05, p < 0.001), and considerably more inpatient care (OR 1.44, 95% CI 1.43-1.45, p < 0.001) than people in the highest income quantile. The largest relative inequality was observed for mortality (OR 1.78, 95% CI 1.74-1.82, p < 0.001).

Overall, the lowest income quantile utilized a decreasing proportion of primary and outpatient care, despite having increasing mortality rates, reflective of an increased need. The disparities between inequalities in health care utilization and mortality were most pronounced for neoplasms and chronic respiratory diseases, while being less prominent for neurological disorders.

"To deliver health care in proportion to needs and to ensure efficient use of health care resources, the health sector should promote motivated utilization of primary- and specialized care among low-income groups," the authors say.

Flodin adds, "By comparing the trends in income-related differences in health care utilization with trends in mortality inequalities, we here provide evidence of increasing inequalities in utilization of primary and outpatient care over time."