Characteristics of employment history and self-perceived barriers to healthcare access
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Characteristics of employment history and self-perceived barriers to healthcare access. / Hoven, Hanno; Backhaus, Insa; Gerő, Krisztina; Kawachi, Ichiro.
in: EUR J PUBLIC HEALTH, Jahrgang 33, Nr. 6, 09.12.2023, S. 1080–1087.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Characteristics of employment history and self-perceived barriers to healthcare access
AU - Hoven, Hanno
AU - Backhaus, Insa
AU - Gerő, Krisztina
AU - Kawachi, Ichiro
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.
PY - 2023/12/9
Y1 - 2023/12/9
N2 - BACKGROUND: Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators.METHODS: We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics.RESULTS: Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators.CONCLUSION: Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.
AB - BACKGROUND: Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators.METHODS: We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics.RESULTS: Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators.CONCLUSION: Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.
U2 - 10.1093/eurpub/ckad178
DO - 10.1093/eurpub/ckad178
M3 - SCORING: Journal article
C2 - 37857366
VL - 33
SP - 1080
EP - 1087
JO - EUR J PUBLIC HEALTH
JF - EUR J PUBLIC HEALTH
SN - 1101-1262
IS - 6
ER -