Assessing inequalities in preventive care use in Europe.

This paper presents new international evidence on the extent of inequalities in breast cancer screening and blood test (cholesterol and blood sugar test) in 13 European Countries using data from the 2009 wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). One important contribution of the paper is the inclusion of preexisting health conditions in the needs standardization procedure with the aim of taking into account utilization due to diagnosis or follow-up reasons. We find evidence of pro-rich inequalities in blood test use in some countries while high inequalities emerge in virtually every country with respect to mammography use. Decomposition analysis reveals that inequalities in mammography use are mostly driven by income while preventive needs distribution is only slightly pro-rich. On the other side, richer individuals appear to be much more likely to do blood tests despite their substantially lower diagnostic needs for that care. Generally, inequalities in mammography use are higher in countries without national breast cancer screening programs or in countries with only regional or less participated programs. Inequalities in blood tests are higher in countries with a high share of out-of-pocket payments and/or non universalistic entitlement to insurance coverage.