Unbiased Analysis of Today's Healthcare Issues

Socioeconomic Status and Wait Times in Europe

Written By: Jason Shafrin - Dec• 17•09

One of the most contentious parts of the healthcare debate in the U.S. is whether or not to move towards a more European style of health care.  Those in favor cite the equality of the system, the lower cost, and lower administrative cost.  Those against rail against the lack of provider choice and the long wait times for many specialist services (see graphic).

But do all people in Europe experience the same waiting period for medical care?  A paper by Sicilliani and Verzulli (2009) find that individuals with higher socioeconomic status have shorter wait times in Europe.

…individuals with high education experience a reduction in waiting times of 68% in Spain, 67% in Italy and 34% in France (compared with individuals with low education). Individuals with intermediate education report a waiting-time reduction of 74% in Greece (compared with individuals with low education). There is also evidence of a negative and significant association between education and waiting times for non-emergency surgery in Denmark, the Netherlands and Sweden.”

However, the authors don’t attempt to explain why individuals with higher socioeconomic status have shorter wait times.  Here are some explanations I came up with:

  • Private health insurance spillovers.  Let us assume that the government allocates healthcare resources on a per person basis.  Also assume that wealthier individuals are more likely to buy private health insurance.  If this is the case, wealthy/educated individuals living in “better” neighborhoods will experience shorter waits at the government run health centers because many of their neighbors will be using privately supplied medical services.
  • Buying votes.  The government may allocate more healthcare dollars to neighborhoods with wealthier individuals.  Politicians may do this to court the votes (and donation dollars) of the wealthier voters.
  • Tiebout sorting.  Let us assume that healthcare quality is randomly distributed geographically.  Property values will increase in areas with better public health facilities.  The people who can afford homes/rents in these high-quality healthcare neighborhoods will naturally be those who can afford it (i.e., those with higher socioeconomic status.)
  • Personal connection.  Physicians have high socioeconomic status and are more likely to be friends with patients who have high socioeconomic status.  Thus, they may be doing favors for their friends by getting them in earlier.  This likely happens, but does not explain the large disparities Sicilliani and Verzulli find.
  • Rich people complain.  If more educated individuals are more likely to complain about long wait times, physicians may have an incentive to schedule them first.
  • Bribes.

Any others?

Source:  Sicilliani L and Verzulli R (2009) “Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE,” Health Economics, v18(11):1295-1306.

You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

7 Comments

  1. […] reading here: Healthcare Economist · Socioeconomic Status and Wait Times in Europe Share and […]

  2. […] link: Healthcare Economist · Socioeconomic Status and Wait Times in Europe Share and […]

  3. Seems to me all is explained looking at the difference between inpatient surgery and outpatient surgery times. Rich people can efford to go to a private clinic. I don’t know about other countries but in Italy most private clinics are subsedisez by the state anyway – you can then choose: have your service performed at the state hospitals for penny or pay bit more (nothing even remotely close to american amounts) and go to a private clinic.

  4. […] insurance at all, wait times are probably considerable here too).  Jason Shafrin has written an interesting article about wait times to see a specialist in Europe, and the role that socioeconomic status plays.  I […]

  5. Nancy G. says:

    Those with higher SES generally have strong communication skills and are probably better able to 1) articulate their needs assertively and 2) better able to work the system. That’s my theory, anyway.

  6. […] insurance at all, wait times are probably considerable here too).  Jason Shafrin has written an interesting article about wait times to see a specialist in Europe, and the role that socioeconomic status plays.  I […]

  7. Ildiko M. says:

    Does somebody have the original Sicilliani and Verzulli (2009) paper or a working paper version of it? I need it urgently!Thank you!

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>