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Open Access Research article

Inequalities in utilisation of general practitioner and specialist services in 9 European countries

Irina Stirbu1*, Anton E Kunst12, Andreas Mielck3 and Johan P Mackenbach1

Author Affiliations

1 Department of Public Health, Erasmus Medical Centre Rotterdam, Erasmus University, The Netherlands

2 Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, The Netherlands

3 Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Germany

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BMC Health Services Research 2011, 11:288  doi:10.1186/1472-6963-11-288

Published: 31 October 2011



The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions.


Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health.


People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension.


We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases.

health utilization; specialist services; socio-economic inequalities; Europe