Care or not care--that is the question: predictors of healthcare utilisation in relation to employment status.
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.


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


METHODS
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.
Department of Public Health and Caring Sciences, Social Medicine, Uppsala University, Uppsala Science Park, SE-751 85, Uppsala, Sweden. annika.ahs@pubcare.uu.se
Annika
A
Åhs
Gunilla
G
Burell
Ragnar
R
Westerling
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden; D014478:Unemployment; D055815:Young Adult