Open Access
Trends and equity in the use of health services in Spain and Germany around austerity in Europe
(BMC, 2021) Moreno Lostao, Almudena; Lostao Unzu, Lourdes; Beller, Johannes; Sperlich, Stefanie; Ronda, Elena; Geyer, Siegfried; Pulido, José; Regidor Poyatos, Enrique; Soziologia eta Gizarte Lana; Institute for Advanced Social Research - ICOMMUNITAS; Sociología y Trabajo Social
Background: following the 2008 economic crisis many countries implemented austerity policies, including reducing public spending on health services. This paper evaluates the trends and equity in the use of health services during and after that period in Spain - a country with austerity policies - and in Germany - a country without restriction on healthcare spending. Methods: data from several National Surveys in Spain and several waves of the Socio-Economic Panel in Germany, carried out between 2009 and 2017, were used. The dependent variables were number of doctor's consultations and whether or not a hospital admission occurred. The measure of socioeconomic position was education. In each year, the estimates were made for people with and without pre-existing health problems. First, the average number of doctor's consultations and the percentage of respondents who had had been hospitalized were calculated. Second, the relationship between education and use of those health services was estimated by calculating the difference in consultations using covariance analysis - in the case of number of consultations - and by calculating the percentage ratio using binomial regression - in the case of hospitalization. Results: the annual mean number of consultations went down in both countries. In Spain the average was 14.2 in 2009 and 10.4 in 2017 for patients with chronic conditions; 16.6 and 13.5 for those with a mental illness; and 6.4 and 5.9 for those without a defined illness. In Germany, the averages were 13.8 (2009) and 12.9 (2017) for the chronic group; 21.1 and 17.0 for mental illness; and 8.7 and 7.5 with no defined illness. The hospitalization frequency also decreased in both countries. The majority of the analyses presented no significant differences in relation to education. Conclusion: in both Spain and Germany, service use decreased between 2009 and 2017. In the first few years, this reduction coincided with a period of austerity in Spain. In general, we did not find socioeconomic differences in health service use.
Open Access
Use of health services according to income before and after elimination of copayment in Germany and restriction of universal health coverage in Spain
(BioMed Central, 2018) Lostao Unzu, Lourdes; Geyer, Siegfried; Albaladejo, Romana; Moreno Lostao, Almudena; Ronda, Elena; Regidor Poyatos, Enrique; Sociología; Soziologia
Background: In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country. Methods: Data were taken from the 2009 and 2014 Socio-Economic Panel conducted in Germany, and from the 2009 and 2014 European Health Surveys in Spain. The health services investigated were physician consultations and hospital admissions, and the measure of socioeconomic position used was household income. The magnitude of the relationship between socioeconomic position and the use of each health service in people from 16 to 74 years old was estimated by calculating the percentage ratio using binary regression. Results: In Germany, after adjusting for age, sex, and need for care, in the model comparing the two lower income categories to the two higher categories, the percentage ratio for physician consultation was 0.97 (95% CI 0.96–0.99) in 2009 and 0.98 (95% CI 0.97–0.99) in 2014, and the percentage ratio for hospitalization was 1.01 (95% CI 0.93–1.10) in 2009 and 1.16 (95% CI 1.08–1.25) in 2014. In Spain, after adjusting for age, sex, and self-rated health, the percentage ratio for physician consultation was 0.99 (95% CI 0.94–1.05) in 2009 and 1.08 (95% CI 1.03–1.14) in 2014, and the percentage ratio for hospitalization was 1.04 (95% CI 0.92–1.18) in 2009 and 0.99 (95% CI 0.87–1.14) in 2014. Conclusion: The results suggest that elimination of the copayment in Germany did not change the frequency of physician consultations, whereas after the restriction of universal health coverage in Spain, subjects with lower incomes had a higher frequency of physician consultations.
Open Access
Socioeconomic position and health services use in Germany and Spain during the Great Recession
(Public Library of Science, 2017) Lostao Unzu, Lourdes; Geyer, Siegfried; Albaladejo, Romana; Moreno Lostao, Almudena; Santos, Juana M.; Regidor Poyatos, Enrique; Sociología; Soziologia
Objective: The relationship of socioeconomic position with the use of health services may have changed with the emergence of the economic crisis. This study shows that relationship before and during the economic crisis, in Germany and in Spain. Methods: Data from the 2006 and 2011 Socio-Economic Panel carried out in Germany, and from the 2006 and 2011 National Health Surveys carried out in Spain were used. The health services investigated were physician consultations and hospitalization. The measures of socioeconomic position used were education and household income. The magnitude of the relationship between socioeconomic position and the use of each health services was estimated by calculating the percentage ratio by binary regression. Results: In Germany, in both periods, after adjusting for age, sex, type of health insurance and need for care, subjects belonging to the lower educational categories had a lower frequency of physician consultations, while those belonging to the lower income categories had a higher frequency of hospitalization. In the model comparing the two lower socioeconomic categories to the two higher categories, the percentage ratio for physician consultation by education was 0.97 (95%CI 0.96–0.98) in 2006 and 0.96 (95%CI 0.95–0.97) in 2011, and the percentage ratio for hospitalization by income was 1.14 (95%CI 1.05–1.25) in 2006 and 1.12 (95%CI 1.03–1.21) in 2011. In Spain, no significant socioeconomic differences were observed in either period in the frequency of use of these health services in the fully adjusted model. Conclusion: The results suggest that the economic crisis did not alter accessibility to the health system in either country, given that the socioeconomic pattern in the use of these health services was similar before and during the crisis in both countries.

Lostao Unzu, Lourdes

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