Inequalities in health care use among older adults in Sweden 1992-2011: a repeated cross-
sectional study of Swedes aged 77 years and older
Sammanfattning
Aims: In the last decades, the Swedish health care system was reformed to promote free choice;
however, it has been questioned whether older adults benefit from these reforms. It has also been
proposed that reforms promoting free choice might increase inequalities in health care use. Thus, the
aim of this study is to investigate socioeconomic differences in health care use among older adults
in Sweden, from 1992 to 2011. Methods: The Swedish Panel Study of the Living Conditions of the
Oldest Old (SWEOLD) is a nationally representative study of Swedes over 76 years old, including
both institutionalized and community-dwelling persons. We analyzed cross-sectional data from
SWEOLD waves in 1992, 2002 and 2011 (n = 600/wave); and performed multivariate analyses to
investigate whether socioeconomic position was associated with health care use (inpatient,
outpatient and dental services) after need was accounted for. Results: For the period of 1992-2011,
we found that higher education was associated with more use of outpatient and dental care, both
before and after adjustment for need. The association between education and inpatient or outpatient
care use did not change over time. There was an increase in the proportion of older adults whom
used dental care over the 19-year period, and there was a tendency for the socioeconomic
differences regarding dentist visits to decrease over time. Conclusions: Our study covering 19 years
showed relatively stable findings for socioeconomic differences in health care use among older
adults in Sweden. We found there was a slight decrease in inequality in dental care; but unchanged
socioeconomic differences in outpatient care, regardless of the changes that occurred in the Swedish
health care system.