Association between socioeconomic status and primary healthcare utilisation in Portugal

Background The public Portuguese primary health care (PHC) model includes a capitation component, where family physicians (FP) are partly financed based on a list of users, weighted by their age. Socioeconomic status (SES) has been identified as a potential factor influencing the utilisation of consultations, suggesting that the user list dimension should also be adjusted according to this parameter. This paper aims at measuring the association between SES and the use of PHC consultations, to identify whether SES should be used as adjustment factor in capitation. Methods The 2019 National Health Survey database (N = 10,115) was used to model the probability and frequency of PHC consultations as a function of SES variables, including educational level, income level, employment status, and insurance and subsystems status, adjusting for age, sex, and nationality. We employed a multivariable two-part model, and an adjustment for unmet needs was performed as additional analysis. Results Unemployed, retired, or disabled/inactive persons utilised PHC levels more frequently (0.09, 0.07 and 0.19 more consultations, respectively). In contrast, students, those with primary and lower secondary education, and those residing in a couple family household with children attended PHC facilities with less frequency (0.18 and 0.08 fewer consultations, respectively). Conclusion Specific SES determinants contribute to unequal levels of PHC use. A balanced, weight-adjusted combination of these factors in the formulation of PHC lists is key for optimising workloads while ensuring equitable provision of care aligned to population needs.