The Social Insurance Institution of Finland, Helsinki, Finland.
PLoS One. 2023 Aug 9;18(8):e0288423. doi: 10.1371/journal.pone.0288423. eCollection 2023.
The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services.
Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls.
The use of health services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational health services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of health services.
When access to occupational healthcare services ceases, other health services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status.
本研究旨在探讨失业前后不同医疗保健领域门诊医疗服务的使用情况，并研究失业是否影响了这些服务的使用。
本研究采用纵向个体水平基于登记的芬兰奥卢市所有于 2017 年失业个体（n=1999）及其倾向得分匹配对照者（n=1999）和未匹配对照者（n=58459）的准实验设计。使用门诊医疗服务在失业前 12 个月至失业后 12 个月的一个月期间进行了检查。采用了多种社会人口学因素、疾病和就业史来进行匹配。采用差异中的差异分析来衡量失业者与其匹配对照者在门诊医疗服务使用方面的差异。
失业后门诊医疗服务的使用显著下降。这是由于职业健康服务使用减少所致。在公共或私人医疗服务的使用方面，未观察到与失业相关的变化。失业结束后，医疗就诊次数再次增加。差异中的差异分析表明，与倾向得分匹配对照者相比，失业会减少卫生服务的使用。
当获得职业保健服务的机会丧失时，其他卫生服务似乎并不能填补失业者的空白。应根据需要为所有人群平等地提供足够的医疗服务，而不论其劳动力市场地位如何。
