Countries with strong primary care show more equity in health
The health level among highly- and low-educated people is more equal in countries with a high-quality primary care. For people with low education, primary care can function as a gatekeeper, reducing the correlation between education level and health. This is shown in a new dissertation in sociology from the Swedish Institute for Social Research (SOFI) at Stockholm University.
The world’s general health is improving, and our life expectancy is increasing. Still, there’s an expanding health gap within nations. Maria Forslund, newly appointed PhD in sociology, examines this subject in her dissertation “From the cradle to the grave – in sickness and in health? The welfare state and health outcomes”.
Her thesis studies the interplay between health care, cash benefits, life expectancy and health inequity. The results, which are based on data from 24 countries, show a connection between strong primary care systems and equity in self-rated health.
– I compared the self-rated health of low-educated people, with the health of high school and university graduates. In countries with strong primary care systems, the connection between health and education level was weaker, said Maria Forslund.
Previous research within the field has been focusing on cash benefits, such as sick pay, unemployment insurance and pensions. Other publicly funded services have been less investigated.
– Health care is a very complex field. It covers so many different areas, apart from where the care is carried out – like technology and the pharmaceutical industry. So the research objects are not obvious, said Maria Forslund.
Her study uses OECD’s measurement of primary care quality. It assumes that a group of diseases – asthma, chronic obstructive pulmonary disease, high blood pressure, congestive heart failure and diabetes – should be able to be treated in primary care, without hospitalization. The lower hospitalization rates for these diseases, the more effective the primary care system, according to this model.
Health inequity increases with age
Maria Forslund stresses primary care’s role in preventing these diseases at an early stage.
– Chronical diseases are demanding for the individual patient, and you need to check symptoms regularly. Still, low-income patients do not seek health care to the extent one would expect. Meanwhile, high-income patients do it more often than one would expect. There’s a general imbalance. High-quality primary care functions as a gatekeeper, reducing these effects, said Maria Forslund.
The results also show that health inequities based on education level increase with age. This find surprised Forslund:
– Low-educated people tend to get diseases earlier in life, which means they might need earlier preventive support in primary care. There is an accumulation perspective: if you get sick early in life, you might have a hard time entering the workforce. You fall behind, and in midlife this becomes apparent. It seems that people with high education experience a longer life period before they seek health care.
She argues that primary care systems should be improved, in order to decrease the individual’s responsibility for their own health care.
– This responsibility should be lifted from the individual to a societal level. In many cases, the people most ill are the people with the smallest resources to take an active role in their care, said Maria Forslund.
How the study was done
The study uses observational data from the "European Social Survey" and the first 9 waves collected, which corresponds to the time period 2002-2018. The people who participated were asked to rate their health and also state other background factors such as age, gender and level of education. This data was combined with data on quality in primary care produced by the OECD for 24 countries: Belgium, Denmark, Estonia, Finland, France, Iceland, Israel, Italy, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Spain, Slovenia, Slovakia, Switzerland, Sweden, United Kingdom, Czech Republic, Germany, Hungary and Austria. The study does not show casualty between health level and primary care quality.
Read more about the research
"From the cradle to the grave – in sickness and in health?: The welfare state and health outcomes"
Contact
Maria Forslund, PhD in sociology at the Swedish Institute for Social Research (SOFI) at Stockholm University
Last updated: March 21, 2023
Source: SOFI