Differences that hurt: Self-perceived health inequalities in Croatia and European union

Aim To investigate the differences in self-reported health status and access to health care according to different income groups, urbanization level, and regional distribution in Croatia and European Union (EU) countries. Method Data for the EU countries were taken from the European Quality of Life Survey database, which examines different aspects of quality of life including health and health care. The survey was conducted in 2003 and covered 28 countries, although not Croatia. The survey in Croatia was conducted in 2006 by the United Nations Development Program Croatia. EU countries were divided into two groups - 15 "old" EU member states which joined the EU before May 2004 (EU 15) and 10 new member states which joined the EU in May 2004 (NMS). The samples were representative and comprised persons aged 18 and over. Statistical differences in health status and access to health care between categories and groups (income groups, urban-rural divide, and analytical regions in case of Croatia) were tested by chi(2) test or analysis of variance. Results Significant differences were found among 4 income quartiles in Croatia and two EU country groups in all indicators: self-perceived health status, satisfaction with health, having long-standing illness or disability, access to health care according to four indicators (distance to the nearest medical facility, delay in getting an appointment, waiting time to see the doctor on the day of the appointment, and the cost of seeing the doctor), and the quality of health services. Higher proportion of the Croatian citizens in the lowest income quartile reported poor health (27.8%) than their counterparts in the EU15 (9.2%) or NMS (18.6%). In Croatia, 26% respondents in the lowest quartile perceived the distance to the nearest medical facility as a very serious problem, compared with 5.4% in the EU15 and 9.4% in the NMS. Rural urban proportion ratio of those who reported poor health was about 80% higher in Croatia than in both EU country groups. Rural-urban proportion ratio of those who reported the cost of seeing the doctor as a very serious problem was almost 2-fold higher than in the two EU country groups. Conclusion Health inequalities were more marked in Croatia than in EU countries, which should be taken into serious consideration in shaping health care reforms in Croatia.