HEALTH FOR EVERYONE?.

Foreword
Acknowledgements
Acronyms and abbreviations
Executive summary
	Poor health behaviour tends to be more prevalent among the disadvantaged, but the relationship between risk factors and educational level can be complex
	No matter how it is measured, the least educated are more likely to be in bad health
	People with low income are less likely to see a doctor while access to preventive services is systematically concentrated among the better off
	Unmet needs for care are systematically concentrated among lower income groups and poor households face more difficulties to afford care when they access the system
	There is some consistency when comparing inequalities across various health domains
	A range of policy options exists to reduce social inequalities in health
1 Health-related inequalities: Framework and key findings
	1.1. Why a report on health-related inequalities? Introduction and method
		1.1.1. Health is essential to well-being and increases a person’s chance of being productive…
		1.1.2. …but the odds are stacked in favour of the better-off
		1.1.3. Health systems and policies can contribute to redressing the balance
		1.1.4. This report provides a comparative assessment of health-related inequalities in 33 OECD and EU economies
	1.2. Key findings on inequalities related to health
		1.2.1. Poor health behaviour is more prevalent among the disadvantaged
		1.2.2. Across all countries, the chance that the least educated assess their health as poor is twice as high as for those with a high level of education
	1.3. Key findings on inequalities in health systems
		1.3.1. More often than not, the use of curative and preventive services is concentrated among the better-off
			The better-off are more likely to see a doctor than the poor but once access is established the number of visits varies less systematically with income
			For preventive services, the probability of utilisation raises with income in most countries
			Some countries are better at ensuring a more equal distribution of various types of care than others
		1.3.2. The less well-off are more likely to report unmet needs
			All types of unmet needs are more concentrated among the least well-off
			Some countries concentrate inequalities in unmet needs
		1.3.3. Even if access to care is assured, it can lead to financial hardship – especially for the poor
			Low-income households are more likely to face catastrophic health expenditure
	1.4. Conclusions
		1.4.1. In all health domains analysed, inequalities to the detriment of the most disadvantaged prevail
		1.4.2. Some pattern emerge when jointly analysing inequalities across different domains
		1.4.3. Policies to redress inequalities in health
		1.4.4. Inequality is only one dimension when assessing the performance of a health system
		1.4.5. A better harmonisation of national health surveys is desirable to make international comparisons more robust
	References
		Annex 1.A. Summary tables
		Notes
2 Inequalities in health and its determinants
	2.1. Introduction
	2.2. Poor health outcomes are detrimental to labour market participation
		2.2.1. Everywhere, ill health is associated with low employment rates
			People in poor health have a lower probability of being employed
			In the absence of ill health, labour market participation could increase by 3 percentage points
		2.2.2. Absenteeism is significantly higher among those with higher numbers of deteriorated health indicators
		2.2.3. The chance of being fully productive is higher among people in good health than among those in poor health
	2.3. Behavioural risk factors are unequally distributed across socio-economic groups
		2.3.1. Poor health behaviour is more prevalent among the disadvantaged
			Everywhere, the least educated women are more likely to be overweight
			In most EU and OECD countries, the people with the lowest level of education are more likely to smoke
			There is no clear social gradient in heavy drinking in the majority of countries
		2.3.2. Some countries concentrate inequalities in behavioural risk factors
	2.4. Socio-economic inequalities in health outcomes
		2.4.1. Inequalities in longevity by socio-economic status are substantial
		2.4.2. Socio-economic differences in morbidity are also marked
			In all countries, the least educated have a higher risk of assessing their own health as poor
			Absolute inequalities in self-assessed health are the highest in Portugal, Luxembourg Hungary, the Slovak Republic and the United States
		2.4.3. Summary of inequalities in health status
			Some countries concentrate education-related inequalities in health status
			The ranking of countries is broadly consistent when using an alternative measure of inequalities
			Using income as a proxy of socio-economic status provides a different grouping of countries
	2.5. Synthesis and conclusion
		2.5.1. Poor health undermine people’s ability to work
		2.5.2. Exposure to behavioural risk factors becomes more prevalent as education decreases
		2.5.3. All countries display inequalities in health to the detriment of the least educated people
		2.5.4. Policy responses need to be comprehensive, and to better target those most affected
	References
		Annex 2.A. Detailed results on Chapter 2
		Detailed results on labour market variables
		Detailed results on risk factors
		Detailed results on health status
		Notes
3 Inequalities in the utilisation of health care services
	3.1. Introduction
	3.2. Income-related inequalities exist in the utilisation of some – but not all – health care services across EU and OECD countries
		3.2.1. In most countries, for a given level of needs, access to the doctor increases with income level but less so for GPs
			Higher income translates into a higher needs-adjusted probability of seeing a doctor
			Once access to a GP is secured, low-income patients have at least as many if not more visits to the GP than the rich in all but one country
			The higher people’s income, the more likely they are to see a specialist, for a given level of needs, in 29 out of 32 countries
		3.2.2. Access to hospital services does not depend on income in most countries
		3.2.3. Summary of inequalities in utilisation of curative services
	3.3. Lower income people use preventive services less frequently
		3.3.1. In virtually all countries, cancer screening is less frequently availed by people with lower income
		3.3.2. All countries, except Ireland, show inequalities in dentist visits in favour of people with higher income
		3.3.3. Flu vaccination among the elderly seems more evenly distributed among income groups than other preventives services
		3.3.4. Summary of inequalities in utilisation of preventive services
	3.4. Synthesis and conclusion
		3.4.1. With differences in needs factored in, the utilisation of curative and especially preventive services is generally more concentrated among high income groups
		3.4.2. Some countries are better at ensuring a more equal distribution of various types of care than others
		3.4.3. Inequalities in the utilisation of care is only one aspect of the access question
	References
		Annex 3.A. Additional results on inequalities in utilisation of care
		Utilisation of physician and hospital care
		Preventive services
		Notes
4 Inequalities in unmet needs for health care
	4.1. Introduction
	4.2. Unmet needs for health care: a commonly used indicator of access
		4.2.1. Unmet needs: a pragmatic but specification-sensitive indicator of access
		4.2.2. On average, more than one in four adults report facing barriers in access across EU and OECD countries
			In many countries, people who experience barriers to care have a lower utilisation of health services than those who do not.
			Some people who can be expected to have regular contacts with the system fail to do so but generally do not attribute this to barriers in access.
	4.3. Lower income people are often less likely to find services readily available
		4.3.1. Delays in obtaining care due to waiting times are more frequent among low-income people in half of the countries studied
		4.3.2. In most countries, delayed or forgone care due to transport problems is concentrated among those with low income and people living in rural areas
		4.3.3. Summary of inequalities in unmet needs due to problems of service availability
	4.4. Everywhere lower-income people are more likely to delay or forgo care because of the cost
		4.4.1. Affordability is more of a barrier to care among the poor
		4.4.2. Dental care is more frequently forgone due to cost than medical care or prescribed medicines
		4.4.3. Summary of inequalities in unmet needs for financial reasons
	4.5. Synthesis and conclusions
		4.5.1. All types of unmet needs are more concentrated among the least well-off
		4.5.2. Some countries concentrate inequalities in unmet needs
		4.5.3. Policy responses must be adapted to the barriers to care and target those most affected
	References
		Annex 4.A. Additional results on unmet needs
	Description of variables
	Numerical results
	Explanation and Sensitivity analysis
	Graphs of generalised concentration indexes
	Notes
5 Affordability and financial protection: Insights from Europe
	5.1. Introduction
	5.2. Affordability and financial protection are concerns in Europe, especially for the poor
		5.2.1. On average thirty percent of households below the poverty line in Europe find it difficult to afford health services
		5.2.2. In countries with high out-of-pocket spending, lower-income people spend a higher share of their household budget on health
		5.2.3. Catastrophic and impoverishing health spending are issues in some European countries
	5.3. Most people in OECD and EU countries have access to publicly financed coverage
		5.3.1. Access to publicly financed coverage is near-universal in many European and OECD countries
		5.3.2. Voluntary health insurance plays a marginal role except in a handful of countries
	5.4. The design of coverage, particularly public, can improve affordability
		5.4.1. Across the EU and OECD, hospital and outpatient care is better covered than pharmaceuticals and dental care
		5.4.2. Variation in the financial protection at service level can explain differences in the financial burden of health care costs
		5.4.3. Policy levers can help reduce financial hardship of households, especially for the poor
	5.5. Conclusion
	References
		Annex 5.A. Data on financial protection using indicators for global monitoring
	Notes