Introduction Ethnic variations in healthcare consumption do not necessarily reflect inequities (variations that are avoidable, unfair and unjust). We analysed the usefulness of the literature for interpretation of ethnic variations in healthcare consumption, and the data requirements for further research.
Methods Conceptual review of empirical studies based on healthcare registry data.
Results Studies documenting ethnic variations in healthcare consumption, and studies using healthcare consumption data to define quality of care indicators and subsequently comparing these across ethnic groups, are not conclusive on (in)equity of care. If such studies include analysis of the impact of ethnic variations in consumption on health outcomes, and if medical need and other explanatory variables are taken into account, conclusions on (in)equity of care are possible. Following Andersen's model and its clinical adaptation by Rathore (2004), we specified the explanatory variables needed to understand ethnic variations in healthcare consumption and their effect on health outcomes as: objective medical need, socio-economic factors, patient preferences, lifestyle and therapy adherence. We found no published studies or datasets allowing for comprehensive analyses of causal associations of healthcare consumption and health outcomes.
Conclusions The literature does not provide sufficient evidence to distinguish between ethnic variations in healthcare consumption reflecting systemic inequities and those reflecting ethnic variations in medical need. The distinction has important policy implications, because the first requires measures to overcome ethnic bias in care, the second ethnic targeting of services.
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