Change and persistence in healthcare inequities: Access to elective surgery in Finland in 1992–2003

Aims: Many countries experience persistent or increasing socioeconomic disparities in specialist care. This study examines the socioeconomic distribution of elective surgery from 1992 to 2003 in Finland. Methods: Administrative registers were used to identify common elective procedures performed in all public and private hospitals in Finland in 1992–2003. Patients’ individual sociodemographic data came from 1990–2003 census and employment statistics databases. First coronary revascularisation, hip and knee replacement, lumbar disc operation, cataract extraction, hysterectomy and prostatectomy on residents aged 25–84 years were analysed. Age-standardized procedure rates by income quintile were calculated for both genders, and concentration indices were developed and applied to age-standardized procedure rates in 5% income groups for each study year. Results: Most procedure rates increased during the study period. Three trends emerged: declining inequality for coronary revascularisations, an increase and then a decline in cataract extractions and primary knee replacements among men, and positive relationships between income and treatment for hysterectomy and lumbar disc operations. Conclusions: Our results suggest that structural features – uneven availability, co-payments and plurality of provision – sustain inequity in access; decreasing inequities reflect directed service expansion. Increased attention to collective, prospective funding of primary and specialist ambulatory care is required to increase equity of access to elective surgery.