Care or Not Care—that is the Question: Predictors of Healthcare Utilisation in Relation to Employment Status

Article

Abstract

Background

International research shows that there is a higher use of care among the unemployed than among the employed, although the findings on the association between unemployment and healthcare use are not conclusive.

Purpose

To examine the association between healthcare use and employment status and the factors influencing this relationship.

Method

During 2002, a questionnaire was sent to 1,000 persons who had recently registered as unemployed (participation rate: n = 570) and to a sample of 1,000 persons representing the Swedish population (participation rate: n = 641). The study design was cross-sectional. Persons still unemployed or otherwise not employed (n = 416) were compared with the employed (n = 414) using logistic regression analyses.

Results

About half of those in the unemployed group had contacted a physician. The unemployed were also more likely to have needed but not sought care. Being in the unemployed group was a statistically significant risk factor for reporting unmet care needs, after adjusting for sociodemographic factors (OR = 1.53). The risk of abstaining from seeking care did not persist when considering economy and social network. Among those with unmet care needs, there was still a higher risk in the unemployed group of reporting: a small social network (OR = 2.73), economic hardship (OR = 2.87) and symptoms of depression (OR = 2.04).

Conclusions

Unemployment is a risk factor for both contacting a physician and for unmet care needs. A low social network and economic hardship are more present among persons who abstain from seeking healthcare and seem to be more common among the unemployed. The healthcare system should also be aware of the fact that some unemployed people with symptoms of depression abstain from seeking care.

Keywords

Unemployment Healthcare utilisation Unmet care needs Symptoms of depression Social network Economic hardship 

Notes

Acknowledgements

The study was supported by grants from the Institute for Labour Market Policy Evaluation and the Swedish Council for Working Life and Social Research. All the authors contributed to the conception of the study. AÅ participated in the design of the study, analysis, and writing of the article. GB participated in the design, interpretation, and drafting of the manuscript. RW participated in the design, interpretation, analysis, and drafting of the manuscript.

The manuscript has not been published elsewhere and it has not been submitted simultaneously for publication elsewhere. However, the manuscript is based on a study preliminarily reported in the doctoral thesis: “Health and HealthCare Utilisation among the Unemployed” at Uppsala University, Faculty of Medicine, Department of Public Health and Caring Sciences, 2006.

References

  1. 1.
    McKee-Ryan F, Song Z, Wanberg CR, Kinicki AJ. Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol. 2005;90(1):53–76.PubMedCrossRefGoogle Scholar
  2. 2.
    Claussen B. Health and re-employment in a five-year follow-up of long-term unemployed. Scand J Public Health. 1999;27(2):94–100.PubMedGoogle Scholar
  3. 3.
    Mastekaasa A. Unemployment and health: selection effects. J Community Appl Soc Psychol. 1996;6(3):189–205.CrossRefGoogle Scholar
  4. 4.
    Pohjola A. Health problems and long-term unemployment. Soc Work Health Care. 2001;34(1–2):101–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Carr Hill RA, Rice N, Roland M. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. BMJ Br Med J. 1996;312(7037):1008–12.CrossRefGoogle Scholar
  6. 6.
    Field KS, Briggs DJ. Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health Soc Care Community. 2001;9(5):294–308.PubMedCrossRefGoogle Scholar
  7. 7.
    Kraut A, Mustard C, Walld R, Tate R. Unemployment and health care utilization. Scand J Work Environ Health. 2000;26(2):169–77.PubMedCrossRefGoogle Scholar
  8. 8.
    Virtanen P. Unemployment, re-employment and the use of primary health care services. Scand J Prim Health Care. 1993;11(4):228–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Åhs A, Westerling R. Health care utilization among persons who are unemployed or outside the labour force. Health Policy. 2006;78:178–93.PubMedCrossRefGoogle Scholar
  10. 10.
    Kristenson M. Self-rated health and biological mechanisms: a literature review. Stockholm: Forskningsrådsnämnden (FRN); 2000.Google Scholar
  11. 11.
    Dooley D, Catalano R, Wilson G. Depression and unemployment: panel findings from the epidemiologic catchment area study. Am J Community Psychol. 1994;22(6):745–65.PubMedCrossRefGoogle Scholar
  12. 12.
    France C, Lee C, Powers J. Correlates of depressive symptoms in a representative sample of young Australian women. Aust Psychol. 2004;39(3):228–37.CrossRefGoogle Scholar
  13. 13.
    Montgomery SM, Cook DG, Bartley MJ, Wadsworth ME. Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men. Int J Epidemiol. 1999;28(1):95–100.PubMedCrossRefGoogle Scholar
  14. 14.
    Grossi G, Theorell T, Jurisoo M, Setterlind S. Psychophysiological correlates of organizational change and threat of unemployment among police inspectors. Integr Physiol Behav Sci. 1999;34(1):30–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Hallsten L, Bellaagh K, Gustafsson K. Burnout in Sweden—a national survey. (In Swedish). Arbete och hälsa. Solna: Arbetsmiljöinstitutet; 2002. p. 6.Google Scholar
  16. 16.
    Shirom A. Reflections on the study of burnout. Work Stress. 2005;19(3):263–70.CrossRefGoogle Scholar
  17. 17.
    Burström B. Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s? Health Policy. 2002;62(2):117–29.PubMedCrossRefGoogle Scholar
  18. 18.
    Gerdtham UG, Sundberg G. Equity in the delivery of health care in Sweden. Scand J Soc Med. 1998;26(4):259–64.PubMedGoogle Scholar
  19. 19.
    Korten AE, Jacomb PA, Jiao Z, Christensen H, Jorm AF, Henderson AS, et al. Predictors of GP service use: a community survey of an elderly Australian sample. Aust NZ J Public Health. 1998;22(5):609–15.CrossRefGoogle Scholar
  20. 20.
    Eriksson T, Maclure M, Kragstrup J. Consultation with the general practitioner triggered by advice from social network members. Scand J Prim Health Care. 2004;22(1):54.PubMedCrossRefGoogle Scholar
  21. 21.
    Broadhead WE, Gehlbach SH, deGruy FV, Kaplan BH. Functional versus structural social support and health care utilization in a family medicine outpatient practice. Med Care. 1989;27(3):221–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Fritzell S, Burström B. Economic strain and self-rated health among lone and couple mothers in Sweden during the 1990s compared to the 1980s. Health Policy. 2006;79(2–3):253–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Carpenter JS, Andrykowski MA, Wilson J, Hall LA, Rayens MK, Sachs B, et al. Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues Ment Health Nurs. 1998;19(5):481–94.PubMedCrossRefGoogle Scholar
  24. 24.
    Kohout FJ, Berkman LF, Evans DA, Cornoni Huntley J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993;5(2):179–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRefGoogle Scholar
  26. 26.
    Kushnir T, Melamed S. The Gulf War and its impact on burnout and well-being of working civilians. Psychol Med. 1992;22(4):987–95.PubMedCrossRefGoogle Scholar
  27. 27.
    Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular diseases. Behav Med. 1992;18(2):53–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Rasky E, Stronegger WJ, Freidl W. Employment status and its health-related effects in rural Styria, Austria. Prev Med. 1996;25(6):757–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Hammarström A, Janlert U, Theorell T. Youth unemployment and ill health: results from a 2-year follow-up study. Soc Sci Med. 1988;26(10):1025–33.PubMedCrossRefGoogle Scholar
  30. 30.
    Claussen B. A clinical follow up of unemployed. I: lifestyle, diagnoses, treatment and re-employment. Scand J Prim Health Care. 1993;11(3):211–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Taris T. Unemployment and mental health: a longitudinal perspective. Int J Stress Manage. 2002;9(1):43–57.CrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2010

Authors and Affiliations

  • Annika Åhs
    • 1
  • Gunilla Burell
    • 1
  • Ragnar Westerling
    • 1
  1. 1.Department of Public Health and Caring Sciences, Social MedicineUppsala UniversityUppsalaSweden

Personalised recommendations