Collie Alex, Sheehan Luke, McAllister Ashley
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
BMC Health Serv Res. 2021 Mar 19;21(1):249. doi: 10.1186/s12913-021-06255-0.
Healthcare is funded and delivered separately from income support programs such as unemployment and disability benefits. Greater understanding of the health service use (HSU) of benefit recipients would support more effective design and delivery of health and income support programs. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, while controlling for personal, household and health-related factors associated with HSU in benefit recipients.
A cross-sectional national survey of 9110 working age Australian adults in three groups: (1) 566 receiving the disability support pension (DSP); (2) 410 receiving unemployment benefits; and (3) 8134 earning wages. Outcomes included prevalence and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using prevalence ratios and incident rate ratios, adjusted for predisposing, enabling and need factors that may affect HSU.
In adjusted regression models, both DSP and unemployment benefit recipients were significantly more likely than wage earners to have consulted psychologists and social workers. DSP recipients also reported a significantly higher prevalence of consultations with General Practitioners (GPs), specialist physicians and podiatrists.. Both groups reported significantly more frequent consultations with GPs and DSP recipients with specialists. No differences were observed between groups for hospital attendance or admission, or supplement use in fully adjusted models, though the DSP group reported more prevalent medication use than wage earners. Inclusion of confounders including self-assessed health, disability severity, health insurance status, and financial resources attenuated the relationship between benefit receipt and HSU, however significant associations were still observed.
People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics explained much, but not all, of the association between greater HSU and benefit receipt. Greater coordination between health and income support systems may improve health, reduce HSU and improve work ability in unemployed and working age people.
医疗保健的资金来源和提供方式与失业救济和残疾福利等收入支持计划是分开的。更好地了解福利领取者的医疗服务使用情况，将有助于更有效地设计和实施医疗与收入支持计划。本研究旨在描述残疾和失业福利领取者相对于有工资收入者的医疗服务使用情况，同时控制与福利领取者医疗服务使用相关的个人、家庭和健康因素。
对9110名澳大利亚工作年龄成年人进行了一项全国性横断面调查，分为三组：（1）566名领取残疾支持养老金（DSP）的人；（2）410名领取失业救济金的人；（3）8134名有工资收入的人。结果包括过去12个月内与医疗专业人员咨询的患病率和频率、住院就诊和入院情况，以及过去2周内药物和补充剂的使用情况。分析使用患病率比和发病率比，将DSP和失业救济金领取者与有工资收入者进行比较，并对可能影响医疗服务使用的易患因素、促成因素和需求因素进行了调整。
在调整后的回归模型中，DSP和失业救济金领取者咨询心理学家和社会工作者的可能性均显著高于有工资收入者。DSP领取者与全科医生（GP）、专科医生和足病医生咨询的患病率也显著更高。两组与全科医生咨询的频率均显著更高，DSP领取者与专科医生咨询的频率也更高。在完全调整后的模型中，两组在住院就诊或入院情况以及补充剂使用方面未观察到差异，尽管DSP组报告的药物使用患病率高于有工资收入者。纳入包括自我评估健康状况、残疾严重程度、健康保险状况和财务资源等混杂因素后，福利领取与医疗服务使用之间的关系有所减弱，但仍观察到显著关联。
领取失业和残疾保险福利的人比有工资收入的人使用的医疗服务显著更多。一系列个人和临床特征解释了医疗服务使用增加与福利领取之间的大部分但并非全部关联。医疗与收入支持系统之间加强协调，可能会改善健康状况、减少医疗服务使用，并提高失业者和工作年龄人群的工作能力。
