Variations in preventive care utilisation in Europe

Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing
effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation
of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and
over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the
British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side
health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation
both within and across European countries. In all countries, controlling for individual health status and country-level systemic
differences, higher educated and higher income groups use more preventive services. At the health system level, high public
health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does
not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives
to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services,
including cancer screening, are higher.