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Research – Health and care costs of Dutch divorcees 48% above national average (RIVM, 2007)

December 19, 2007

Dutch cost-of-healthsystem-research over the year 2003 published on December 19th, 2007, showed that the average care costs of divorcees are 48% above the Dutch national average pro person. The more frequent use made of specialist and hospital care by divorcees can only be partly attributed to the slightly poorer average health status of these groups.

Source: Social differences in health care utilisation and costs in the Netherlands in 2003; Kunst A.E., Meerding W.J., Varenik N., Polder J.J., Mackenbach J.P., Dutch RIVM report 270751017, ISBN: 978-90-6960-173-1, 76 p in Dutch, 2007: Full report in Dutch

RIVM Press release
Within the Netherlands, there are substantial social inequalities in care consumption and health care costs. People differ in terms of their use of care facilities. This is influenced by factors such as their socio-economic position, mode of cohabitation and country of origin. The present study reveals that this effect is even more pronounced than previous research has indicated.

Social inequalities were identified in the use of virtually all types of care facilities. These inequalities are also substantial when translated into health care costs. In terms of costs per resident, it is estimated that individuals with an HBO qualification (professionally oriented higher education) or a university degree are 11% below the national average, while those who only received a primary-school education are 21% above that level. The average care costs of widowed individuals and divorcees are 31% and 48% above the national average, respectively. Conversely, the cost of care for people of non-Western origin are relatively low, but they are still 15% above the national average. It is worth noting that the same percentage applies to non-indigenous individuals of Western (mainly European) origin.

The main reason for this is that lower socio-economic groups have more health problems. So, this study concludes that each euro spent on health care generally ends up in the right place, i.e. where there is the greatest need for care. This underscores the enormous importance of risk solidarity in the Dutch health service. This study also illustrate the fact that combating health deprivation can help us to manage the level of care expenditure in the Netherlands.

RIVM – Bilthoven – the Netherlands

RIVM Report Summary
Previous studies have revealed a great deal about how care consumption and health care costs are distributed across age groups, and between men and women in the Netherlands. Conversely, less is known about the distribution of care between social groups. What we do know is that there are substantial inequalities between various sub-groups of the population of the Netherlands in terms of health. These health inequalities might also be expected to correspond to variations in care consumption and health care costs between different social groups. This report gives an estimate of these social inequalities with regard to the use of the Dutch health care system and the costs involved. The data cover the period from 2001 to 2003.

Within the Netherlands, there are substantial social inequalities in care consumption and health care costs

People differ in terms of their use of care facilities. This is influenced by factors such as their socio-economic position (SEP), mode of cohabitation, and country of origin. The present study reveals that this effect is even more pronounced than previous research has indicated. Unlike previous studies, ours was not restricted to an investigation of the likelihood of care consumption. It also addressed the amount of care that users receive. Accordingly, it was found that social groups at greater risk of being admitted to hospital were also hospitalized for longer, on average.

Social inequalities were identified in the use of virtually all types of care facilities. The substantial variation in the use made of mental health care (GGZ), social work, district nursing and family care corresponds to people’s SEP and mode of cohabitation. In this regard, three-fold or four-fold differences in the levels of use were not unusual. Slightly smaller differences (one-and-a-half fold to two fold) were found for visits to the GP, hospitalization, and use of prescribed medication.

The relationship between care consumption and country of origin was less pronounced. People of non-Western origin differ from other ethnic groups (including the indigenous population) only in terms of visits to their GP, and in the use that they make of social work and ambulant mental health care services.

Social inequalities in the Netherlands are also substantial when translated into health care costs. In terms of costs per resident, it is estimated that individuals with an HBO qualification (professionally oriented higher education) or a university degree are 11% below the national average, while those who only received a primary-school education are 21% above that level. The average care costs of widowed individuals and divorcees are 31% and 48% above the national average, respectively. Conversely, the cost of care for people of non-Western origin are relatively low, but they are still 15% above the national average. It is worth noting that the same percentage applies to non-indigenous individuals of Western (mainly European) origin.

The main reason for this is that lower socio-economic groups have more health problems

The substantial social inequalities in care consumption can be almost completely attributed to the fact that those with a low SEP, people living alone, and non-indigenous individuals generally have poorer health than the rest of the population. This means that these people tend to consume about the same amount of care as people from other groups with a roughly equivalent health status. It also means that, to a large extent, social inequalities in health care costs ultimately derive from the fact that substantial social inequalities in health still exist in the Netherlands. It is worth noting that the health inequalities in question could be both a cause and an effect of a low SEP and of certain modes of cohabitation. Thus a poor education can increase the risk of health problems. Conversely, however, mental health problems may prevent people from completing their studies in higher education, which in turn will impair their chances of achieving a higher SEP.

Upon further examination, however, it was found that health inequalities cannot account for all of the social inequalities in care consumption. One example is the more frequent use made of specialist and hospital care by divorcees and those who have been widowed. This can only be partly attributed to the slightly poorer average health status of these groups. Just as striking is the fact that certain underprivileged groups make relatively little use of care, even if their health status is poor. Specialist care is a prime example of relative under-consumption. This is because the less educated make approximately 30% less use of such facilities than might be expected on the basis of their health. Those from groups of non-Western origin also make much less use of specialist and hospital care than one might expect on the basis of their state of health.

Part of the observed variation in care consumption can be attributed to social inequalities in the incidence of specific disorders. The relative contributions to health care costs by individual disorders vary considerably from one social indicator or care sector to another. The major contributors have been identified as cancer, heart disease, diabetes, respiratory tract disorders, and joint disorders.

Each euro spent on health care is used where it does the most good

This study concludes that each euro spent on health care generally ends up in the right place, i.e. where there is the greatest need for care. People’s social position largely determines their risk, at any given stage in their lives, of having to make use of the health care system. The main cause of these social inequalities in care consumption is that health problems in the Netherlands are concentrated among lower socio-economic groups, people living alone, and ethnic groups. The resultant substantial social inequalities in care consumption serve to underscore the enormous importance of risk solidarity in the Dutch health service. They also illustrate the fact that combating health deprivation can help us to manage the level of care expenditure in the Netherlands.

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