Socio-economic differences in health, income inequality, unequal access to care and spending on health: A country-level comparison of Finland and 16 other European countries

Abstract

In all countries, there are differences in health between socio-economic groups. In Finland those health differences are comparatively large. Why there is such wide cross-national variation in relative health differences between socio-economic groups remains an unanswered question. One brand of explanations links health outcomes to income inequalities. The other brand of explanations emphasizes the role of health care systems and unequal access to health care. The latter explanation has dominated the Finnish debate, which is motivated by the fact that the OECD has classified the Finnish health care system as one of the most unequalizing in the industrial countries. A third set of explanations argues that health outcomes are related to the size of the health budget. In this article, we focus on socio-economic differences in selfassessed health. We ask how strongly socio-economic health differences are linked to income inequalities (H1), how satisfactorily the characteristics of health care systems explain these differences (H2), and what the relative role of the health budget is (H3). The comparisons show that the socio-economic health differences among 17 European countries are more strongly associated to the health budget (H3) than to the features of health care systems (H2) or income inequality (H1). However, these two explanations also get qualified support— but bigger seems to be better.