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The European Journal of Public Health Advance Access published online on November 23, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp189
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Inequalities that hurt: demographic, socio-economic and health status inequalities in the utilization of health services in Serbia

Janko Jankovic1, Snezana Simic1 and Jelena Marinkovic2

1Institute of Social Medicine, School of Medicine, University of Belgrade, Belgrade, Serbia
2Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia

Correspondence: Janko Jankovic, Institute of Social Medicine, School of Medicine, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia, tel: +381 11 2643 830, fax: +381 11 2659 533, e-mail: drjankojankovic{at}yahoo.com

Received May 7, 2009 , accepted October 19, 2009

Background: The aim of this study was to analyse demographic, socio-economic and health status inequalities by gender in the utilization of health services in Serbia. Methods: Data from 2006 National Health Survey for Serbia were used. A total of 14 522 persons from six geographical regions of Serbia aged ≥20 years were completely interviewed. Logistic regression analyses were used to study the effects of demographic (age, gender, marital status and type of settlement), socio-economic (education and Wealth Index) and health status (self-perceived health) variables on the utilization of health services [visits to general practitioner (GP), private doctor, dentist and hospitalization]. All analyses were carried out separately for males and females. Results: As compared with women (reference category), a lower percentage of men visited a GP [odds ratio (OR) = 0.61; 95% confidence interval (95% CI) = 0.57–0.65], private doctor (OR = 0.62; 95% CI = 0.57–0.67) and dentist (OR = 0.81; 95% CI = 0.76–0.87), but there were no gender differences in hospitalization. Both males and females who belong to disadvantaged classes were less likely to have visited a GP, a private doctor or a dentist in 12 months before the interview, regardless of their health status. No inequalities by social class were observed for the hospitalization among persons with poor self-perceived health status, i.e. those in most need. Conclusions: This study has shown that demographic, socio-economic and health status inequalities in the utilization of health services exist in Serbia. Wise health policy with equitable utilization of health services, regardless these inequalities should be a priority in shaping Serbian health care system reform.

Keywords: health service utilization, health survey, inequalities in health, Serbia, social class


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