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[Association of income with use of and access to health services in Spain at the beginning of the XXI century].

OBJECTIVE
To estimate the association of household income and provincial income with visits to general practitioners and specialists and with hospitalization and to determine whether waiting times to access these services vary with both economic variables.


METHOD
Data from the 2001 National Health Survey were used. The association was estimated by sex- and age-adjusted odds ratios; in the case of per capita income, odds ratios were also adjusted for household income. Percentiles and the geometric mean of waiting times in each health service were estimated and the statistical significance of their association with both economic variables was evaluated.


RESULTS
Subjects with the lowest household income showed the highest frequency of visits to general practitioners and hospitalization, although they waited longer for hospital admission. Subjects with the lowest household income also showed the lowest frequency of specialist visits: the odds ratio in the lowest income quartile with respect to the highest income quartile was 0.73 (95% CI: 0.62-0.87). However, when only visits to specialists working in the public system were analyzed, the lowest frequency of visits was observed in subjects with the highest household income. No differences were found in health services utilization or in waiting times according to provincial income.


CONCLUSIONS
The frequency of specialist visits according to household income shows a different pattern from that observed for visits to general practitioners and hospitalizations. The longest waiting times for admission to hospital were observed in subjects with the lowest household income.