Social class inequalities in the use of and access to health services in Catalonia, Spain:: what is the influence of supplemental private health insurance?

Objective. To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. Design. 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. Setting. Catalonia (Spain). Study participants. The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n = 12 245). Main outcome measures. Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. Results. Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes ni and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). Conclusion. The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.