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Due to the special role which they can play in the utilization of specialist services, GPs are also included in the study.
Most studies of socioeconomic inequalities in utilization of specialist services are general population studies.
Patient experiences with general practice were associated with the patients' level of utilization of specialist services.
Socioeconomic inequalities in the utilization of specialist services have been found in many countries and for a wide range of diagnoses.
Beyond studies of utilization of specialist services, the majority of research has focused on understanding the factors that determine referrals to specialists by primary care physicians (PCPs) [ 10, 14- 21].
There are socioeconomic inequalities in patient experiences with general practice, however the aspects measured in this study do not explain the observed socioeconomic inequity in utilization of specialist services.
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In 2005, France implemented a gatekeeping reform designed to improve care coordination and to reduce utilization of specialists' services.
The probability of specialist services utilization was distributed in disfavor of persons with lower household income and lower education (education RII = 0.83, 95% CI 0.75-0.91), and lower education and household income were associated with a lower number of visits to specialists (education RII = 0.62, 95% CI 0.57-0.62).
In particular, these were related to availability of specialist services.
Dunlop et al. [ 7] found that lower socioeconomic status (SES) was associated with increased use of primary care and lower rates of specialist service utilization, whereas health needs as measured by perceived health status and health condition predicted utilization across the board.
Two recent reviews concluded that having multiple diseases leads to a rise in specialized care, such as the utilization of specialist physician services, hospital admissions, and the number and length of hospital stays [ 1, 14].
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