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Fair care: four essays on the allocation and utilization of health care
Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Essay I: Conceptions of Justice and Health Care Utilization. This essay reviews and discusses different theories of social justice in the context of health care allocation. In the Western world, equity is seen as being achieved when persons of similar health status receive the same level of health care; and the general question is whether support for allocation according to need is to be found in the various theories. Support for this principle is found above all in egalitarian theories, but support for it may also be found in utilitarian, envy-free and decent minimum theories - it is a matter of interpretation of the theories. On the other hand, need has no relevance for theories that stress entitlement, merit or desert as the proper criteria for allocation. A fair allocation refers not only to who is given access, but also what they are given access to. Finally, the essay briefly discusses distribution at societal level, i.e. what type of care is considered to be important, what kind of needs should be given priority.

Essay II: Equality of Access to Medical Care in Sweden. This essay focuses on three common socioeconomic indicators that may influence people's access to medical care, namely occupational class, education and economic resources. The main aim is to investigate whether these factors determine access to medical care in Sweden, indicated by use of medical services and foregone care. Where utilization of medical care is concerned, the aim is to disentangle the ways in which occupational class, education and disposable family income are related, both separately and simultaneously, to the utilization of five types of medical care. Moreover, in order to ascertain whether severe health problems reduce the influence of socioeconomic position on health care utilization, further analyses look at visits to physicians and emergency departments by people with poor and fair health respectively. The results indicate that occupational class, education and income are related, both separately and together (included in the same model), to the use of some of the included types of medical care. The analyses of whether poor health reduces the influence of socioeconomic position on health care utilization give very little support for such an assumption. Where foregone care is concerned an interesting paradox becomes apparent: the results indicate that economically vulnerable women make considerably more use of medical care than those who are better off, even though they are also more likely to forego physician care when they need treatment.

Essay III: Economic Resources and Health Care Utilization: Use of medical and dental services in Sweden 1968, 1981 and 1991 Essay III studies the relationship between personal economic resources and health care utilization at three points in time - 1968, 1981 and 1991. The analysis focuses on differences in visits to physicians and dentists between two groups with differing economic resources (disposable family income) and changes in utilization within these groups over time. The results indicate an increase in utilization between 1968 and 1991 for both groups. However, different utilization trends resulted in diminished differences between men with differing economic resources, whereas the differences among women remained significant. The reduction in differences in income seems only marginally to explain the reduction in differences in utilization.

Essay IV: Foregone Care: Do Patient Fees Restrict Access to Health Care? Patient fees have been put forward as an important barrier to access to medical care. If economically vulnerable groups have to refrain from seeking health care, then the aim of Swedish healthcare legislation, namely that good care should be available to everyone on equal terms, is at risk. This essay investigates whether patient fees have been a reason for abstaining from visiting a physician or a dentist, and to what extent economic vulnerability affects this tendency. The results show that patient fees are an important reason for foregoing medical and dental care as expressed by the respondents themselves. Furthermore, those who are economically vulnerable are significantly more likely to refrain from visiting a physician, and even more likely to refrain from visiting a dentist. These findings indicate that great care must be taken when patient fees are set, because of the risk of reducing access to health care among poor and vulnerable groups. 

Place, publisher, year, edition, pages
Stockholm: Swedish Institute for Social Research [Institutet för social forskning] , 2001. , 17 p.
Series
Swedish Institute for Social Research, ISSN 0283-8222 ; 50
National Category
Sociology
Research subject
Sociology
Identifiers
URN: urn:nbn:se:su:diva-72379ISBN: 91-7604-087-9 (print)OAI: oai:DiVA.org:su-72379DiVA: diva2:495628
Public defence
2001-05-17, 10:00 (Swedish)
Opponent
Note

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Available from: 2012-02-09 Created: 2012-02-09 Last updated: 2017-07-10Bibliographically approved

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