Does the Socioeconomic Status Predict Health Service Utilization in Persons with Enhanced Health Care Needs? Results from a Population-based Survey in Persons with Spinal Cord Lesions from Switzerland

Overview

Journal Int J Equity Health

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2022 Jul 12

PMID 35821147

Authors

Christine Fekete

Caroline Debnar

Anke Scheel-Sailer

Armin Gemperli

Affiliations

Soon will be listed here.

Abstract

Background: Evidence suggests that the socioeconomic status (SES) affects individuals' health service utilization. Spinal cord injury is a condition that often leads to physical impairments and enhanced health care needs. It therefore presents an informative and yet under-researched case in point to investigate social inequalities in health service utilization. This study aims to describe associations between SES and health service utilization in adults with spinal cord injury from Switzerland.

Methods: We use cross-sectional data from 1,294 participants of the Swiss Spinal Cord Injury Cohort Study community survey 2017. SES was operationalized with education, household income, perceived financial hardship, subjective status, and granting of supplementary financial benefits. Health service utilization was assessed with information on visits to 13 different health care providers and four health care institutions (inpatient stays, outpatient clinics, emergency departments, specialized spinal cord centers) during the past 12 months. The dichotomized outcomes on service utilization (visited vs. not visited) were regressed on SES indicators, including adjustments for sociodemographics, lesion characteristics, and health status.

Results: Persons with higher SES reported higher likelihood for specialist, dentist, and dental hygienist visits and reported utilizing a larger number of different care providers. Further, specific SES indicators were associated with certain care provider visits (i.e., higher education and subjective status: higher odds for pharmacist visits; higher income: higher odds for natural healer visits; higher subjective status: higher odds for chiropractor visits; supplementary benefit granting: higher odds for general practitioner and home care service visits). We found statistically non-significant trends towards lower likelihood for inpatient stays, outpatient clinic and emergency department visits and enhanced likelihood for specialized spinal cord-center visits in higher SES groups.

Conclusions: This study generally supports the claim that basic health care provision is guaranteed for all patients with spinal cord injury in Switzerland, independently of their SES. However, social inequalities were still observed for the utilization of specific providers, such as oral health care providers. Given that oral health is key for health maintenance in persons with spinal cord injury, specific interventions to enhance regular dental check-ups in lower SES groups are highly recommended.

Citing Articles

Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status.

Lv B, Zhang L, Meng K BMC Public Health. 2023; 23(1):1540.

PMID: 37573398 PMC: 10422842. DOI: 10.1186/s12889-023-16438-5.

Unmet healthcare needs and health inequalities in people with spinal cord injury: a direct regression inequality decomposition.

Ona A, Athanasios K, Tederko P, Escorpizo R, Arora M, Sturm C Int J Equity Health. 2023; 22(1):56.

PMID: 36998015 PMC: 10060928. DOI: 10.1186/s12939-023-01848-z.

References

White I, Royston P, Wood A . Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011; 30(4):377-99. DOI: 10.1002/sim.4067. View

Post M, Brinkhof M, von Elm E, Boldt C, Brach M, Fekete C . Design of the Swiss Spinal Cord Injury Cohort Study. Am J Phys Med Rehabil. 2011; 90(11 Suppl 2):S5-16. DOI: 10.1097/PHM.0b013e318230fd41. View

Mantwill S, Monestel-Umana S, Schulz P . The Relationship between Health Literacy and Health Disparities: A Systematic Review. PLoS One. 2015; 10(12):e0145455. PMC: 4689381. DOI: 10.1371/journal.pone.0145455. View

Guessous I, Gaspoz J, Theler J, Wolff H . High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage. Prev Med. 2012; 55(5):521-7. DOI: 10.1016/j.ypmed.2012.08.005. View

Singh-Manoux A, Marmot M, Adler N . Does subjective social status predict health and change in health status better than objective status?. Psychosom Med. 2005; 67(6):855-61. DOI: 10.1097/01.psy.0000188434.52941.a0. View

Zurcher C, Tough H, Fekete C . Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships. PLoS One. 2019; 14(2):e0206069. PMC: 6382129. DOI: 10.1371/journal.pone.0206069. View

Palencia L, Espelt A, Rodriguez-Sanz M, Rocha K, Pasarin M, Borrell C . Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993-2006. Eur J Health Econ. 2011; 14(2):211-9. DOI: 10.1007/s10198-011-0362-7. View

Filc D, Davidovich N, Novack L, Balicer R . Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?. Int J Equity Health. 2014; 13:115. PMC: 4260253. DOI: 10.1186/s12939-014-0115-1. View

Ballert C, Post M, Brinkhof M, Reinhardt J . Psychometric properties of the Nottwil Environmental Factors Inventory Short Form. Arch Phys Med Rehabil. 2014; 96(2):233-40. DOI: 10.1016/j.apmr.2014.09.004. View

10.

Sangha O, Stucki G, Liang M, Fossel A, Katz J . The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003; 49(2):156-63. DOI: 10.1002/art.10993. View

11.

Yuen H, Shotwell M, Magruder K, Slate E, Salinas C . Factors associated with oral problems among adults with spinal cord injury. J Spinal Cord Med. 2009; 32(4):408-15. PMC: 2830680. DOI: 10.1080/10790268.2009.11753207. View

12.

Ona A, Strom V, Lee B, Le Fort M, Middleton J, Gutenbrunner C . Health inequalities and income for people with spinal cord injury. A comparison between and within countries. SSM Popul Health. 2021; 15:100854. PMC: 8259327. DOI: 10.1016/j.ssmph.2021.100854. View

13.

Geyer S, Hemstrom O, Peter R, Vagero D . Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health. 2006; 60(9):804-10. PMC: 2566032. DOI: 10.1136/jech.2005.041319. View

14.

Scott T, Gazmararian J, Williams M, Baker D . Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002; 40(5):395-404. DOI: 10.1097/00005650-200205000-00005. View

15.

Fekete C, Boldt C, Post M, Eriks-Hoogland I, Cieza A, Stucki G . How to measure what matters: development and application of guiding principles to select measurement instruments in an epidemiologic study on functioning. Am J Phys Med Rehabil. 2011; 90(11 Suppl 2):S29-38. DOI: 10.1097/PHM.0b013e318230fe41. View

16.

Castro S, Sosa E, Lozano V, Akhtar A, Love K, Duffels J . The impact of income and education on lung cancer screening utilization, eligibility, and outcomes: a narrative review of socioeconomic disparities in lung cancer screening. J Thorac Dis. 2021; 13(6):3745-3757. PMC: 8264678. DOI: 10.21037/jtd-20-3281. View

17.

Touhami D, Brach M, Essig S, Ronca E, Debecker I, Eriks-Hoogland I . First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist?. BMC Fam Pract. 2021; 22(1):195. PMC: 8487149. DOI: 10.1186/s12875-021-01547-0. View

18.

Gemperli A, Ronca E, Scheel-Sailer A, Koch H, Brach M, Trezzini B . Health care utilization in persons with spinal cord injury: part 1-outpatient services. Spinal Cord. 2017; 55(9):823-827. DOI: 10.1038/sc.2017.44. View

19.

Ronca E, Scheel-Sailer A, Koch H, Gemperli A . Health care utilization in persons with spinal cord injury: part 2-determinants, geographic variation and comparison with the general population. Spinal Cord. 2017; 55(9):828-833. DOI: 10.1038/sc.2017.38. View

20.

Tzogiou C, Boes S, Brunner B . What explains the inequalities in health care utilization between immigrants and non-migrants in Switzerland?. BMC Public Health. 2021; 21(1):530. PMC: 7977586. DOI: 10.1186/s12889-021-10393-9. View