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Mind the safety net: socioeconomic inequalities in out-of-hours primary care use.

Jansen, T. Mind the safety net: socioeconomic inequalities in out-of-hours primary care use. Utrecht: Nivel, 2020. 197 p. Proefschrift van de Universiteit van Amsterdam
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Background
Although the provision of equal care for equal need is a central policy objective of health systems in many countries, some system arrangements yield more equity than others. The healthcare system therefore offers a setting in which access and use of healthcare services contribute to a certain extent to either diverging or converging inequalities in health outcomes. In countries with strong primary healthcare focussed systems, such as present in the Netherlands, socioeconomic inequalities are relatively small but not absent. Better understanding of the extent to which inequalities in the use of acute healthcare services exist, enables a more targeted approach to facilitate appropriate care at the right time and place, and fosters sustainable use of resources. Therefore, we focussed our research on socioeconomic inequalities in the use of out-of-hours primary care services (OPCSs). These are an extension of daytime general practice for acute but non-life threatening health problems.

Aim
The general aim of this thesis is to quantify socioeconomic inequalities in OPCS use in the Netherlands from different angles, to study changes in inequalities over time, and to determine whether socioeconomic inequalities in OPCS use could partly be explained by health literacy levels.

Research questions
The following research questions were addressed in this thesis:
1. To what extent do socioeconomic inequalities exist in the use of out-of-hours primary care services?
2. How did the use of out-of-hours primary care services according to socioeconomic status develop over time ?
3. To what extent could socioeconomic inequalities in the use of out-of-hours primary care services be explained by health literacy?

Results
Socioeconomic inequalities in health status and health behaviour are reflected in different patterns of healthcare use between socioeconomic groups. Higher socioeconomic status (SES) is related to overall better health and more medically appropriate healthcare use patterns than lower SES. Moreover, with each step down in the socioeconomic hierarchy, both health status and healthcare use patterns tend to turn out less favourable. Individuals with low SES incline to use more acute healthcare services than high SES individuals. However, acute care use impedes the continuity of care, care coordination, and a person-centred approach that specifically benefit socioeconomically
vulnerable individuals due to their generally more complex health problems. Differential use of healthcare services between socioeconomic groups could therefore reinforce socioeconomic inequalities in health.