The educational gradient in self-rated health in Europe: Does the doctor–patient relationship make a difference?

Research suggests that doctor–patient relations have evolved from a doctor-centered, paternalistic approach towards a more patient-centered, egalitarian model of interactions between physicians and their patients. Given the long-running debate on the positive relationship between education and health, the question arises how this development in doctor–patient relations affects social inequalities in health. First, we test in how far egalitarian (e.g. discussing treatment decisions with patients) doctor–patient relations are underlying the education–self-reported health association. Second, we test whether egalitarian and paternalistic (e.g. withholding some information from patients) doctor–patient relations show differential effects on self-reported health across different educational groups. Analyses of the European Social Survey (ESS 2004/05) for 24 countries demonstrate that a more egalitarian doctor–patient relationship does not substantially reduce educational inequalities in self-reported health. However, some direct positive effects of egalitarian and direct negative effects of paternalistic doctor–patient relations on health ratings can be found. Finally, results show how the health status of the lower educated can improve with a more egalitarian and less paternalistic doctor–patient relationship.