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[The imperfect equalizing device: Physician care discount cards and physician care out-of-pocket costs in Iceland.].

INTRODUCTION
Research shows that out-of-pocket health care costs in Iceland and other Western European countries have increased in recent years, and unequal access to health services has been documented. In an attempt to contain out-of-pocket-costs and avoid service inequities, Icelandic health authorities have for a number of years issued health care discount cards.


OBJECTIVE
The purpose ot the study was to investigate the distribution of out-of-pocket physician costs and discount cards, and the extent to which the cards reach those who are entitled to them.


MATERIAL AND METHODS
The study is based on a national panel survey titled Health and Living Conditions in Iceland. A random sample of 18-75 year olds was drawn from the National Register. 1924 respondents participated in the first wave (69% response rate) and 1592 of them (83%) in the second wave. Cross-tabular analysis was used to investigate variations in out-of-pocket physician costs and discount card status across sociodemographic groups.


RESULTS
19.9% of the respondents had accumulated out-of-pocket costs that made them eligible for a discount card. Furthermore, there was considerable variation in the percentage of eligible individuals across population groups. The discount card was poorly distributed, as only 45.7% of eligible individuals had actually obtained a card. This lack of coverage was greatest among younger individuals, parents of young children, individuals in larger households, the full-time employed, and those who had more education and income.


CONCLUSIONS
The purpose of the discount card is to even out and contain out-of-pocket physician care costs, and sustain equal access to physician services. The purpose is no more than partially reached, as only a minority of eligible individuals are actual cardholders. This can be largely explained by the fact that health authorities have done little to promote the card, and make it cumbersome for patients to obtain it.