Abstract
We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998–2007. Resource use and costs for years 2008–2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common additional morbidities, income, and to some extent education, had significant effects on the probability of five types of healthcare use. Overall, income showed a bell-shaped relationship to healthcare costs, with patients in income quintiles 2 and 3 having the highest mean annualized cost irrespective of model specification. Education did not have a significant effect in most specifications. Analyses including interaction effects indicated similarly higher costs across income quintiles in the PSO and PsA subgroups, though these cost differences were lower in magnitude for patients with PSO in quintile 5 and with PsA in quintile 1. In conclusion, our results show persistent socioeconomic disparities in healthcare use among a cohort of chronically ill patients and referents, even after controlling for the presence of PSO/PsA and common additional morbidities. These disparities persist even in a country with general healthcare coverage and low out-of-pocket payments.
Highlights
Equity in healthcare is recognized as an important policy issue in most Western countries [1], and many European healthcare systems have a guiding principle aiming at distributing healthcare according to need, often coupled with an organization that reduces the impact of the individual’s inability to pay for healthcare at the point of use.Equity is often discussed in terms of fairness or justice, and health economists have written extensively on thisS
The patients in the cohort were identified by ICD-10 codes associated with PSO and psoriatic arthritis (PsA) using information from a 10-year period, 1998–2007, in the Skane Healthcare Register (SHR), which covers all healthcare used by the population in the Skane region, which is in the southernmost part of Sweden
Consistent with expectations, in Model 1 the probability of visiting a physician or non-physician professional was significantly associated with PSO and PsA across all healthcare levels, with the most pronounced hazard ratio for physician visits in secondary care for those with PsA (HR 2.22, 95% confidence intervals (CI) 2.09–2.36) (Table 4)
Summary
Equity in healthcare is recognized as an important policy issue in most Western countries [1], and many European healthcare systems have a guiding principle aiming at distributing healthcare according to need, often coupled with an organization that reduces the impact of the individual’s inability to pay for healthcare at the point of use.Equity is often discussed in terms of fairness or justice, and health economists have written extensively on thisS. In addition to age and sex, examples of such characteristics used in the literature are presence of indicators of morbidity or disability [7,8,9,10,11]. Variables such as education, income, employment status and ethnicity have, on the other hand, been cited as examples of factors that by themselves should not drive healthcare use, in empirical analyses they may be a proxy for potential unobserved need [12,13,14]
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