This paper presents new international comparative evidence on the factors driving inequalities in the use of GP and specialist services in 12 EU member states. The data are taken from the 1996 wave of the European Community Household Panel (ECHP). We examine two types of utilisation (the probability of a visit and the conditional number of positive visits) for two types of medical care: general practitioner and medical specialist visits using probit, truncated Negbin and generalised Negbin models. We find little or no evidence of income-related inequity in the probability of a GP visit in these countries. Conditional upon at least one visit, there is even evidence of a somewhat pro-poor distribution. By contrast, substantial pro-rich inequity emerges in virtually every country with respect to the probability of contacting a medical specialist. Despite their lower needs for such care, wealthier and higher educated individuals appear to be much more likely to see a specialist than the less well-off. This phenomenon is universal in Europe, but stronger in countries where either private insurance cover or private practice options are offered to purchase quicker and/or preferential access. Pro-rich inequity in subsequent visits adds to this access inequity but appears more related to regional disparities in utilisation than to other factors. Despite decades of universal and fairly comprehensive coverage in European countries, utilisation patterns suggest that rich and poor are not treated equally.

SUMMARYThis paper considers the dynamics of a categorical indicator of self-assessed health using eight waves (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998) of the British Household Panel Survey (BHPS). Our analysis has three focal points: the relative contributions of state dependence and heterogeneity in explaining the dynamics of health, the existence and consequences of health-related sample attrition, and the investigation of the effects of measures of socioeconomic status, with a particular focus on educational attainment and income. To investigate these issues we use dynamic panel ordered probit models. There is clear evidence of health-related attrition in the data but this does not distort the estimates of state dependence and of the socioeconomic gradient in health. The models show strong positive state dependence and heterogeneity accounts for around 30% of the unexplained variation in health.

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This paper uses the British Health and Lifestyle Survey (1984-1985) data and the longitudinal follow-up of May 2003 to investigate the determinants of premature mortality risk in Great Britain. A behavioral model, which relates premature mortality to a set of observable and unobservable factors, is considered. We focus on unobservable individual heterogeneity and endogeneity affecting the mortality equation. A MSL approach for a multivariate probit (MVP) is used to estimate a recursive system of equations for deaths and lifestyles. This model is then compared with the univariate probit models that include or exclude lifestyles. In order to detect inequality in the distribution of health within the population and to calculate the contribution of socioeconomic factors, we compare the range measure of health inequality to the Gini coefficient for overall health inequality. A Gini decomposition analysis for predicted premature mortality shows that endogenous lifestyles and unobservable heterogeneity strongly contribute to inequality in mortality, reducing the role of socio-economic status. JEL codes I1 C0

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