Inequality and inequity in health care use among older people in the United Kingdom

An area that remains relatively unexamined in the literature on older people is horizontal equity in health care service use. The purpose of this study is to investigate the extent of income-related inequity in the use of GP, inpatient, outpatient and dentist services among individuals aged 65 and older in the UK between 1997 and 2003 using data from the BHPS. The probability of GP, outpatient, dentist or inpatient service use between 1997 and 2003 was predicted using multiple random effects logistic regression panel models and income-related horizontal inequity was calculated. An inequity index that is equal to zero implies that after controlling for differences in need across income groups, individuals have equal probability of service use, regardless of income. The results indicate that individuals on lower income are significantly more likely to visit a GP, or use outpatient and inpatient care than the better-off, while the reverse is seen for dental care. After adjusting for differences in need with income, horizontal inequity is found favouring those on higher income for all service areas, particularly outpatient and dental care.