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Health Place. 2014 Jan;25:19-25. doi: 10.1016/j.healthplace.2013.09.011. Epub 2013 Oct 14.

Socioeconomic patterns in use of private and public health services in Spain and Britain: implications for equity in health care.

Author information

  • 1(a)Department of Sociology, Sociology of Health, Universidad Pública de Navarra, Campus de Arrosadía s/n, 31006 Pamplona, Navarra, Spain; (b)Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address:
  • 2(b)Department of Primary Care and Public Health, Imperial College London, London, UK; (c)ESRC International Centre for Life Course Studies in Society and Health, London, UK.
  • 3(d)Division of Epidemiology, Human Genetic and Environmental Sciences, The University of Texas School of Public Health, San Antonio Campus, San Antonio, TX, USA; (e)Department of Epidemiology and Public Health, University College London, London, UK.
  • 4(f)Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Spain; (g)CIBER Epidemiología y Salud Pública (CIBERESP), Spain.


This paper estimates the pattern of private and public physician visits and hospitalisation by socioeconomic position in two countries in which private healthcare expenditure constitutes a different proportion of the total amount spent on health care: Britain and Spain. Private physician visits and private hospitalisations were quantitatively more important in Spain than in Britain. In both countries, the use of private services showed a direct socioeconomic gradient. In Spain, the use of public GPs and public specialists tends to favour the worst-off, but no significant differences were observed in public hospitalisation. In Britain, with some exceptions, no significant socioeconomic differences were observed in the use of public health care services. The different pattern observed in the use of public specialist services may be due to the high frequency of visits to private specialists in Spain.

© 2013 Published by Elsevier Ltd.


Britain; Equity in health care; Private health care; Public health care; Spain

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