National and regional trends in equity within specialised health care in Finland in 2002-2010.

Aims: Equity is an important goal of health-care systems. Nevertheless, previous research indicates that health-care systems do not deliver health services equitably and that socio-economic differences in both health and health-care use may even be increasing. The aim of this study was to investigate national and regional time trends in equity within specialised health care in Finland. Methods: The data used in the study were obtained from the Hospital Discharge Register covering all hospital admissions in Finland from 2002 to 2010 for patients having utilised specialised non-psychiatric inpatient care. Income data were individually linked to these register data. Equity was measured in terms of concentration index at hospital district level. Results: Concentration indices across hospital districts and years were negative, suggesting specialised inpatient care to be distributed pro poor. Overall, the concentration indices remained fairly stable during the study period. However, a drop in the indices appeared in all hospital districts between 2005 and 2008, and a reverse development was found after 2008. In internal medicine departments of the hospital districts, the distribution of the indices was more pro poor compared to surgery but the trends within both specialties were similar to those within specialised care in general. Conclusions: The pro-poor distribution of concentration indices is consistent with morbidity differences. The introduction of the waiting time guarantee in 2005, which brought along an increment in resources, as well as the launch of new regulations and financial incentives, probably increased access to specialised health care among low-income patients temporarily.