Equity in the delivery of health care in Europe and the US

Research output: Contribution to journalArticle


This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives. (C) 2000 Elsevier Science B.V.


  • Eddy Van Doorslaer
  • Adam Wagstaff
  • Hattem Van Der Burg
  • Terkel Christiansen
  • Diana De Graeve
  • Inge Duchesne
  • Michael Gerfin
  • José Geurts
  • Lorna Gross
  • Unto Häkkinen
  • Jürgen John
  • Jan Klavus
  • Robert E. Leu
  • Brian Nolan
  • Owen O'Donnell
  • Carol Propper
  • Frank Puffer
  • Martin Schellhorn
  • Gun Sundberg
  • Olaf Winkelhake
External organisations
  • Erasmus University Rotterdam
  • University of Sussex
  • University of Southern Denmark
  • University of Antwerp
  • Stockholm School of Economics
  • University of Bern
  • Statistics Netherlands
  • Clark University
  • National Institute for Health and Welfare
  • Helmholtz Zentrum München
  • Economic and Social Research Institute Ireland
  • University of Kent
  • University of Bristol
  • Uppsala University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Economics


  • Health care utilization, Horizontal equity, International comparison
Original languageEnglish
Pages (from-to)553-583
Number of pages31
JournalJournal of Health Economics
Issue number5
Publication statusPublished - 2000 Sep 1
Publication categoryResearch
Externally publishedYes