Socioeconomic position and health services use in Germany and Spain during the Great Recession

Abstract

ObjectiveThe relationship of socioeconomic position with the use of health services may have changed with the emergence of the economic crisis. This study shows that relationship before and during the economic crisis, in Germany and in Spain.MethodsData from the 2006 and 2011 Socio-Economic Panel carried out in Germany, and from the 2006 and 2011 National Health Surveys carried out in Spain were used. The health services investigated were physician consultations and hospitalization. The measures of socioeconomic position used were education and household income. The magnitude of the relationship between socioeconomic position and the use of each health services was estimated by calculating the percentage ratio by binary regression.ResultsIn Germany, in both periods, after adjusting for age, sex, type of health insurance and need for care, subjects belonging to the lower educational categories had a lower frequency of physician consultations, while those belonging to the lower income categories had a higher frequency of hospitalization. In the model comparing the two lower socioeconomic categories to the two higher categories, the percentage ratio for physician consultation by education was 0.97 (95%CI 0.96–0.98) in 2006 and 0.96 (95%CI 0.95–0.97) in 2011, and the percentage ratio for hospitalization by income was 1.14 (95%CI 1.05–1.25) in 2006 and 1.12 (95%CI 1.03–1.21) in 2011. In Spain, no significant socioeconomic differences were observed in either period in the frequency of use of these health services in the fully adjusted model.ConclusionThe results suggest that the economic crisis did not alter accessibility to the health system in either country, given that the socioeconomic pattern in the use of these health services was similar before and during the crisis in both countries.

Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review

“…Both found that the onset of the Great Recession was accompanied by a decrease in general practitioner visits [55,58] (although only among the native-born in García-Subirats et al [58]) and hospitalizations [55], and an increase in specialist visits [55,58], while the use of emergency visits remained constant [55]. Lostao et al, who analyzed not only Spain but also Germany, found that in the case of Spain, there were no differences either in general practitioner visits or in hospitalizations [59]. However, it must be taken into account that they did not include as many confounders and, therefore, would not have completely controlled the evaluation problem.…”

Os efeitos permanentes de uma “crise infindável”: a Grande Recessão e as desigualdades na saúde em Espanha

“…More specifically, the average waiting time for surgery rose from 63 to 76 days between 2009 and 2012 (López-Valcárcel and Barber, 2017) and increased further to 93 days in June 2018 (Ministerio de Sanidad, Consumo y Bienestar Social, 2018b). No significant socioeconomic differences in the frequency of use of physician consultations and hospitalizations in Spain were observed in 2007 or 2011 (Lostao et al, 2017). Using the same data (from the Spanish Health Survey) Abásolo et al (2017) found that, in relative terms, the recession has had a greater detrimental effecta decrease in utilizationon low-income groups with respect to specialist appointments and hospitalizations, whereas it has worked to their advantage with respect to emergency services and GP consultations (ibidem).…”

Autopercepción del estado de salud, las desigualdades en salud y la crisis económica: el caso de España

“…Es importante subrayar el aspecto más crucial para entender la paradoja aparente entre la mejora del estado de salud y la crisis económica: los datos globales enmascaran las diferencias entre grupos sociales y en diferentes momentos de la crisis (1,6,8,9,11,12,13) .…”

“…El desempleo, en este grupo, puede haber tenido un efecto paradojal sobre el estado de salud, ya que con la preservación del seguro de desempleo durante los primeros dos años y la reducción de los riesgos asociados a la ocupación en sí, el estado de salud efectivamente podría haber sido percibido como mejor. Asimismo, los recortes en los gastos de salud pública se concentraron más en el deterioro de los salarios del personal de salud que en la oferta de servicios y, por lo tanto, podrían no haber tenido un efecto inmediato en el estado de salud (13) .…”