# _4.2 Economic disparities_

In Table 3, the relationship between the economic status of the household, on the one hand, and health status and health seeking behavior, on the other hand, is examined. One cannot generalize about the relationship between economic status and healthcare utilization. While in Serbia and Kosovo, there is not much variation in hospital utilization across consumption quintiles, in Albania and Bosnia and Herzegovina healthcare utilization falls slightly as economic status increases. Utilization of treatment for acute care is more closely related to economic status than utilization of hospital care, and in all countries utilization of outpatient care tends to increases as economic status improves. The extent of variation across quintiles differs from place to place, though: it is very small in Albania, in Serbia and Kosovo, but nearly doubles in Montenegro.

In Albania, Serbia and Montenegro (i.e. the three countries for which acute illness data are available) the incidence of acute illness falls as economic status rises, in general, but in Serbia and Montenegro, the incidence of acute illness rises sharply again in the richest quintile where a very high incidence of illness is reported. This result could be explained by the possibility that those in the richest quintile are more knowledgeable about their health status because they can afford to have their illnesses diagnosed. There is no clear variation in the incidence of chronic illness across quintiles. This may be the direct consequence of the difficulties of access to preventive health services by poor people, leaving them more vulnerable to illness. Yet, factors that influence illness perception and health seeking behavior are complex. One argument proposed in the literature is that the very poor, lacking the resources to access medical care easily, define illness more narrowly than those able to afford treatment (Falkingham, 2004). The poor may also defer health care utilization until their illness is severe.

There is a very strong direct relationship between economic status and health insurance in all countries for which the information is available: a greater percentage of people in the upper quintiles have health insurance than in the lower quintiles.

**<u>Table 3 Self-reported morbidity and health care utilization, by economic status (%)</u>**

||||**Quintiles o **|**fper capita **|**consumpti**|**on **|
|---|---|---|---|---|---|---|
|||**Poorest**|**2**|**3**|**4**|**Richest**|
||Suffer chronic illness|13.41|15.39|14.29|15.07|14.30|
||Suffer acute illness|8.69|8.69|8.42|7.69|7.65|
|**Albania**|Sought medical assistance /<br>outpatient*|11.75|15.24|13.58|14.05|13.86|
||Hospitalized in the last year**|4.38|4.47|3.87|3.54|3.34|
||People with health insurance|27.77|34.79|43.01|42.37|47.10|
||Suffer chronic illness|26.00|24.00|25.00|28.00|26.00|
|**Bosnia and**<br>|Sought medical assistance /<br>outpatient*|22.34|26.81|32.46|34.29|39.61|
|**Herzegovina**|Hospitalized in the last year**|4.41|4.78|4.55|5.98|4.20|
||People with health insurance|47.84|56.87|59.05|62.35|71.72|
||Suffer chronic illness|5.30|5.10|7.50|5.10|8.50|
||Suffer acute illness|8.00|8.00|6.50|4.10|7.20|
|**Montenegro**|Sought medical assistance /||||||
||<br>outpatient*|7.50|8.12|8.27|5.67|14.30|
||People with health insurance|95.22|94.57|93.22|94.10|97.98|
|**Serbia**|Suffer chronic illness|21.34|22.76|24.13|20.80|21.55|