ECONOMIC RECESSION AND INEQUALITIES IN HEALTH AND HEALTH CARE UTILIZATION IN CATALONIA

Background: Limited knowledge exists on whether or not economic recession is associated with income related inequalities in health and health care utilization. The European financial crisis in 2008 has severely affected Spain. We examine whether socioeconomic inequity in health and health care use widened during the economic downturn in Catalonia. Methods: We use cross sectional data from the Catalan Health Survey conducted in 2006 and in every semester between July 2010 and June 2012. The database is a representative sample of 23,804 non-institutionalized individuals living in Catalonia aged at least 15. Results: During recession we observe pro rich inequity in all health outcomes under examination, namely bad self assessed health, poor mental health and good self assessed health measured by a thermometer index. Regarding, health care use, the horizontal inequity index of most of the health care services retain its sign but changes in magnitude compared to 2006. While inequity in visiting a dentist becomes even more pro rich during the economic recession, inequity in visiting a GP becomes more pro poor. In addition, better off individuals are more likely to visit a specialist during the economic recession compared to 2006. Nevertheless, the magnitude of this trend weakens as recession evolves. Finally, the distribution of visiting the emergencies and hospitalization is slightly pro poor in most of the time spans. Conclusion: The implications of this study depends on whether income related inequity in health and health care utilization increases during the recession and to what extent the implemented measures managed to limit the impact of the financial crisis. Although inequity in health care use and health in most of the cases increases from 2006 to the second semester of 2010, this phenomenon weakens or stabilizes in the following semesters indicating that the measures of Spanish government may have been indeed effective. These results are more obvious in the case of specialists’ services. However, further research is required to confirm that this reduction and stability in inequity is due to the implemented policies.