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

• In Spain the use of public GPs and public specialists tends to favour the worse-off.
• In contrast, no significant socioeconomic differences are observed in public hospitalisation.
• In Britain significant socioeconomic differences in the use of public health care services are not observed.
• The different pattern observed in the use of public specialists may be due to the high frequency of visits to private specialists in 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.