How Have Socioeconomic Inequities in Health Care Utilization Changed Over Time? A Thirty-Year Analysis of the United States of America

Abstract

In 2008, the World Health Organization issued a report calling for urgent action on behalf of governments around the world to address differences in health within and between countries, observing that "social injustice is killing people on a grand scale." Although substantial change has occurred in the United States healthcare system over the past thirty years, empirical studies and anecdotal reports indicate that Americans continue to face worsening health outcomes largely as the result of avoidable systematic differences in the delivery of care. This study examines how socioeconomic inequities in health care utilization have changed in the United States between 1983 and 2011. Specifically, logit regression models are used to calculate differences in the probability of visiting a doctor and being admitted to a hospital, and negative binomial regression models are used to examine population differences in the frequency of use of these services. After controlling for health status and demographic characteristics, the results from most years examined demonstrate that income, education and employment status are key determinants in explaining differences in utilization; however, the probability of an individual being admitted to a hospital is less sensitive to socioeconomic influences than is the utilization of doctor services. Overall findings of this study indicate that a positive relationship exists between socioeconomic status and health care utilization and, although there is slight variation over time, inequities are persistent in the United States healthcare system.