Equity in the Utilization of Health Care in Ireland

Health care provision in Ireland has developed into a complex mixture of public and private provision. The extent of fee paying within the system and strong differentiation between public and private patients has led many to question the degree to which the delivery of health care across those with different financial means is equitable. This paper analyses the extent of equity of health service delivery across the income distribution in Ireland that is the extent to which there is equal treatment for equal need irrespective of income. After first establishing whether we should be examining equity in access to or in the delivery of health care we examine use data representative of the Irish population in 2000 to examine the take up of GP, hospital in-patient, hospital out-patient, dentist, optician and prescription services across the income distribution and find that almost all services, apart from dental and optician services are used more by those at the lower end of the income distribution. However, the extent to which this distribution is equitable depends upon the extent of need for health care across the income distribution and analyses show that those in lower income groups have a far higher need for health care. The comparison of health need to health care delivery across the income distribution without standardising for confounding factors suggests that those in higher income groups receive more health care for a given health status and is thus inequitable. However, need for health care is highest among the elderly and this group also tend to be at the bottom of the income distribution. Once we standardise for age, sex and location we find that hospital services are distributed equitably across the income distribution, whereas GP and prescription services tend to be pro-poor (used more by those with lower incomes for a given health status) and dental and optician services tend to be pro-rich (used more by those with higher incomes for a given health status).