title: Socio-economic Aspects of Health-Related Behaviors and Their Dynamics: A Case Study for the Netherlands.
abstract: BACKGROUND
  Previous studies have mostly focused on socio-demographic and health-related determinants of health-related behaviors. Although comprehensive health insurance coverage could discourage individual lifestyle improvement due to the ex-ante moral hazard problem, few studies have examined such effects. This study examines the association of a comprehensive set of factors including socio-demographic, health status, health insurance, and perceived change in health insurance coverage with health-related behaviors and their dynamics (ie, changes in behavior).
  
  
  METHODS
  Using Survey of Health, Aging, and Retirement in Europe (SHARE) data (a European aging survey among 50+ years old) for the Netherlands in 2004 and 2007 (sample size: 1745), binary and multinomial logit models are employed to study health-related behaviors (daily smoking, excessive alcohol use, and physical inactivity in 2004) and their corresponding changes (stopping or starting unhealthy behavior between 2004 and 2007).
  
  
  RESULTS
  Our findings show that being older, being female, having higher education and living with a partner increase the likelihood not to be a daily smoker or to stop daily smoking. At the same time, being older (OR = 3.02 [1.31, 6.95]) and being female (OR = 1.77 [1.05, 2.96]) increases the likelihood to be or to become physically inactive. We also find that worse perceived health insurance coverage in 2007 is associated with a lower likelihood (OR = 0.19 [0.06, 0.57]) of stopping excessive alcohol use in that year. However, we do not find a strong association between the type of health insurance and health behavior.
  
  
  CONCLUSIONS
  Our findings show that all above mentioned factors (ie, socio-demographic and health status factors) are associated with health-related behavior but not in a consistent way across all behaviors. Moreover, the dynamics of each behavior (positive or negative change) is not necessarily determined by the same factors that determine the state of that behavior. We also find that better perceived health insurance coverage is associated with a healthier lifestyle which is not compatible with an ex-ante moral hazard interpretation. Our results provide input to target policies towards elderly individuals in need of lifestyle change. However, further research should be done to identify the causal effect of health insurance on health-related behavior.
authors.affiliation: Health Management and Economics Research Center (HMERC), Isfahan University of Medial Sciences, Isfahan, Iran.|Department of Health Services Research, CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands.
authors.forename: Reza
authors.initials: R
authors.lastname: Rezayatmand
authors.affiliation: Department of Health Services Research, CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Health Services Research, CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands.|Top Institute for Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057185:Sedentary Behavior; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
keywords: Ex-ante Moral Hazard; Health Insurance; Health-Related Behavior; Healthier Lifestyle; The Netherlands