Abstract
Introduction:Lower socioeconomic position and measures of social and material deprivation are associated with morbidity and mortality. These inequalities in health among groups of various statuses remain one of the main challenges for public health. The aim of the study was to investigate differences in health care use and costs between recipients of social assistance and non-recipients aged 65 years and younger within the Swiss healthcare system.Methods:We analyzed claims data of 13 492 individuals living in Bern, Switzerland of which 391 received social assistance. For the year 2012, we compared the number of physician visits, hospitalizations, prescribed drugs, and total health care costs as covered by mandatory health insurance. Linear and logistic adjusted regression analyses were made to estimate the effect of receipt of social assistance on health service use and costs.Results:Multivariate linear regression analysis revealed that health care costs increased on average by 1 666 CHF if individuals received social assistance. Recipients of social assistance had on average 1.2 more ambulatory consultations than non-recipients and got 1.65 more different medications prescribed as compared to non-recipients. The chance for recipients of social assistance to be hospitalized was almost twice that of non-recipients (Odds Ratio 1.96, 95% confidence interval 1.49-2.59).Conclusions:Recipients of social assistance demonstrate an exceedingly high use of health services. The need for interventions to alleviate the identified inequalities in health and health care needs is obvious.
Highlights
Lower socioeconomic position and measures of social and material deprivation are associated with morbidity and mortality
Multivariate linear regression analysis revealed that health care costs increased on average by 1 666 CHF if individuals received social assistance
Recipients of social assistance had on average 1.2 more ambulatory consultations than non-recipients and got 1.65 more different medications prescribed as compared to non-recipients
Summary
Lower socioeconomic position and measures of social and material deprivation are associated with morbidity and mortality. Lower socioeconomic position and measures of social and material deprivation are associated with greater morbidity including more frequent occurrence of chronic conditions and higher mortality (Marmot et al, 2012; Lampert et al, 2013; Kroll & Lampert, 2013; Charlton et al, 2013) These inequalities in health among groups of various status constitute one of the main challenges for public health (Marmot, 2012; Pons-Vigués et al, 2014). A comparison of OECD countries found that care from general practitioners was distributed but specialist care was biased to patients with higher incomes (van Doorslaer et al, 2006) It is unknown whether deprived persons cannot sufficiently advocate for their own health which results in these inequalities in health care utilization. Even in a rich country such as Switzerland, there is a close www.ccsenet.org/gjhs
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