After taking into account the age, sex and reported level of health of respondents to national surveys, the authors found that - although in many countries general practitioner care is distributed fairly equally and is often even pro-poor (more visits among poorer households) - in all countries surveyed, higher-income people are so much more likely to seek specialist care than lower-income people that total doctor utilization is somewhat pro-rich. The authors also found that this general finding tends to be reinforced in countries where private insurance or private care options are offered. The degree of pro-rich inequity was highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In Canada, as in most countries, there was a pro-poor bias in access to general practitioner care but a pro-rich bias when it came to access to specialty care.