Subproject 5 Health care institutions and inequalities in health care utilisation in young people

When analysing health and socioeconomic inequities in health, consideration must inevitably turn to the health care system, whose predominant purpose is to ensure good and fair health care provision. Health care utilization is a commonly used performance measure, when socioeconomic inequities is focused upon. Socioeconomic inequities in health care utilization are visible as early as in childhood and adolescence. While the influence of state/macro-level characteristics on health care utilization have been subject of scientific research, factors on a lower level, the meso-level of the health care system, have been neglected so far. Additionally, this intermediary level has been scarcely defined in concrete terms.

We identified three dimensions of the health care system’s meso-level, with which the patient interacts, and that mediates/moderates the relationship between children’s socioeconomic position (SEP) and their health care utilization: the dimension of (regional) access, the dimension of provision, respectively the extent, quality and continuity of provision (assuming that these are influenced by the physician to a significant degree) and, lastly, the dimension of health policy.

Against this background, subproject SP5 investigates the following research questions:

  1. Do individual-level determinants contribute to the explanation of health care use inequities in young people and which material, psychosocial and behavioural factors show the strongest relative contribution for the explanation of socioeconomic related health care use inequities among young people?
  2. Do sociodemographic and socioeconomic characteristics influence the use of health care services in childhood and adolescence?
  3. Which of the meso-level characteristics of the health care system related to access account for income-related inequity in health care use?
  4. Do children with high and low socioeconomic position experience a different provision of health care services and does the meso-level of the health care system play a role?
  5. Are health policies at the mesolevel of the health care system, as the reminder scheme to encourage patents to bring their children to preventive medical check-ups (German: “Früherkennungsuntersuchungen”), associated with the health care use of children and adolescents?

Based on a scoping review of the most recent evidence, SP5 will analyse data from the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) and insurance claims data from German statutory health insurances. Analytical Methods include regression models (question 1, 2), decomposition analyses (question 3), identification and analysis of patterns, processes and pathways in the health care provision (question 4) and quasi-experimental methods (question 5).


Department of Health Services Management, Munich School of Management, Ludwig Maximilian University Munich

  • Leonie Sundmacher, Prof. Dr.
  • Tobias Steinherr, M.Sc.
  • Anna Novelli, M.A Dott.ssa Mag.