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Health care utilization among persons who are unemployed or outside the labour force
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
2006 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 78, no 2-3, 178-193 p.Article in journal (Refereed) Published
Abstract [en]

Background: In Sweden, equity in health is a central aim of public health policy. To this end, the health care system is obligated to offer equal access to health care according to need. However, unemployment may hinder the fulfillment of this goal. The aim of the present study was to assess self-reported health care needs and service utilization with respect to employment status.

Methods: A questionnaire was sent to 4000 randomly chosen individuals 20-64 years of age living in different counties in Sweden (response rate 66.2%). Logistic regression analyses were carried out to estimate the influence of employment status, socio-demographic variables and health indicators on the need for and use of health care services.

Results: In total, 42.2% (n=35) among the unemployed, 37.4% (n=55) among persons who were on long-term sick leave (LTSD), and 22.3% (n=467) of the employed persons, abstained from consulting a physician despite reporting a perceived need to do so. The results persisted after adjusting for socio-demographic variables, social support and personal finances (unemployed: OR= 1.91; LTSD: OR= 1.62). The risk of foregoing care remained higher among the unemployed, but not the LTSD-group, after adjusting for long-standing illness (OR= 1.94). The unemployed were more likely than the employed to perceive a need to seek care for psychological problems. The risk of abstaining from consulting a physician was related to symptoms of depression.

Conclusions: Lack of employment may be related to unmet care needs, especially among unemployed who are experiencing psychological symptoms. To deal with the needs of the unemployed it may be useful to develop interventions within the health care system that focus more on psychological problems.

Place, publisher, year, edition, pages
2006. Vol. 78, no 2-3, 178-193 p.
Keyword [en]
Unemployment, Health care utilization, Perceived unmet care needs
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-94982DOI: 10.1016/j.healthpol.2005.10.010ISI: 000240837500007PubMedID: 16343685OAI: oai:DiVA.org:uu-94982DiVA: diva2:169024
Available from: 2006-10-13 Created: 2006-10-13 Last updated: 2016-04-27Bibliographically approved
In thesis
1. Health and Health Care Utilization among the Unemployed
Open this publication in new window or tab >>Health and Health Care Utilization among the Unemployed
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Hälsa och vårdutnyttjande bland arbetslösa
Abstract [en]

The number of persons who are not employed has increased in Sweden since the early 1990s. Unemployment has been found to influence health, especially when unemployment rates are low. The extent to which unemployment affects health when unemployment is high is less clear, and this needs to be further studied. To improve health in the population, the health care system should offer equal access to health care according to need. It is important to study whether the employment status hinders the fulfilment of this goal.

This thesis is based on four papers: Paper I and II aimed at analysing self-rated health versus mortality risk in relation to employment status, during one period of low unemployment and one period of high unemployment. Paper III and IV assessed the use of medical health care services and unmet care needs among persons who were unemployed or otherwise not employed. The goal was to analyse what health problems lead people to either seek or abstain from seeking care, and what factors encumber or facilitate this process.

The overall results indicate that being unemployed or outside the labour force was associated with an excess risk of poor self-rated health, symptoms of depression, mental and physical exhaustion and mortality. The differences in self-rated health between the unemployed and employed were larger when unemployment levels were high, than when they were low. More groups of the unemployed were also afflicted with poor health when unemployment was high. Thus, poor health among the unemployed seems to be a public health problem during high levels of unemployment. Lack of employment was related to abstaining from seeking care, despite perceiving a need for care, and this was related to psychological symptoms. To deal with the needs of the unemployed and others who are outside the labour force it would be useful to develop and implement interventions within the health care system. These should focus on psychological and psychosocial problems. Future research should analyse how to facilitate health-promoting interventions among persons who are not anchored in the labour market.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 183
Keyword
Social medicine, Unemployment, self-rated health, mental health, mortality, health care utilization, health promotion, Socialmedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-7193 (URN)91-554-6682-6 (ISBN)
Public defence
2006-11-03, Hörsalen, Ingång D1, Dag Hammarskjölds väg 17, Uppsala, 13:15
Opponent
Supervisors
Available from: 2006-10-13 Created: 2006-10-13 Last updated: 2016-04-28Bibliographically approved

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Åhs, AnnikaWesterling, Ragnar

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