Equity in Usage of Medical Appointments in Portugal: In Sickness and in Health, in Poverty and in Wealth?

Abstract

Introduction: Equity is a central goal of health policy in Portugal. However, empirical evidence regarding healthcare usage is scarce and there is a lack of up-to-date results. Our objective is to evaluate whether the principle of equal utilisation for equal need has been met.
Material and Methods: We use data from the National Health Survey 2014. Healthcare usage is measured by the number of visits to a Family Physician or to a hospital-based specialist. To assess the factors affecting usage we adopted a multivariate regression analysis (Negative Binomial Model). To quantify income-related inequality/inequity in utilisation we computed the concentration index.
Results: Better self-assessed health and absence of limitations in daily activities decrease usage; suffering from chronic disease increases usage. Income is not statistically significant; education positively affects usage with a pronounced effect. Living in urban areas increases usage as well as living in Lisbon (compared to North). Living in Algarve or Madeira, or benefiting only from the National Health Service coverage negatively affects usage. The possibility for equity in Family Physician visits cannot be discarded. Regarding hospital based specialist and total visits, the evidence suggests the existence of pro-rich inequity.
Discussion: The observed income-related inequity seems to reflect inequalities in other non-need variables. Whether the results are affected by overuse, in the case of hospital based specialist visits, is an issue open to question.
Conclusion: Portugal evolved favourably in terms of equity in healthcare usage but several challenges remain.