The intertwined relationship between patient education, hospital waiting times and hospital utilization

Background: Hospital waiting times are established instruments to ration healthcare when resources are scarce. However, higher educated patients may be better able to influence access to, and exit from, hospital care when waiting times are long. Methods: Based on a representative sample of 11 European countries from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected in 2004/2005, this paper investigates whether the relationship between individual educational background and hospital utilization depends on the prevalent hospital waiting times in a country. Logistic regression with interaction effects between individual education and average waiting times per country are conducted. Results: Primary education is significantly associated with a lower probability of visiting a hospital overnight (OR = 0.88) compared to secondary and tertiary education. Patients in countries with long waiting times had shorter stays (OR = 0.92), and the significant interaction effect indicates that lower educated patients have longer hospital stays than higher educated patients in countries where waiting times tend to be long (OR = 1.06). Conclusions: While the findings imply that educational differences exist with regard to hospital care, future research should investigate potential underlying mechanisms, i.e. patients' perceived access barriers and the perceived quality of hospital treatment.