cc_byLoef,BetteMeulman,IrisHerber,Gerrie-cor M.Kommer,Geert JanKoopmanschap,Marc A.Kunst,Anton E.Polder,Johan J.Wong,AlbertUiters,Ellen2025-02-012025-02-012021Loef, B, Meulman, I, Herber, G M, Kommer, G J, Koopmanschap, M A, Kunst, A E, Polder, J J, Wong, A & Uiters, E 2021, 'Socioeconomic differences in healthcare expenditure and utilization in The Netherlands', BMC Health Services Research, vol. 21, 643. https://doi.org/10.1186/s12913-021-06694-91472-6963crossref: 10.1186/s12913-021-06694-910.1186/s12913-021-06694-9https://hdl.handle.net/20.500.14602/75977Funding This study was funded by the Strategic Program project “Zorgkloof” of the Dutch National Institute for Public Health and the Environment (RIVM).Background: Worldwide, socioeconomic differences in health and use of healthcare resources have been reported, even in countries providing universal healthcare coverage. However, it is unclear how large these socioeconomic differences are for different types of care and to what extent health status plays a role. Therefore, our aim was to examine to what extent healthcare expenditure and utilization differ according to educational level and income, and whether these differences can be explained by health inequalities. Methods: Data from 18,936 participants aged 25–79 years of the Dutch Health Interview Survey were linked at the individual level to nationwide claims data that included healthcare expenditure covered in 2017. For healthcare utilization, participants reported use of different types of healthcare in the past 12 months. The association of education/income with healthcare expenditure/utilization was studied separately for different types of healthcare such as GP and hospital care. Subsequently, analyses were adjusted for general health, physical limitations, and mental health. Results: For most types of healthcare, participants with lower educational and income levels had higher healthcare expenditure and used more healthcare compared to participants with the highest educational and income levels. Total healthcare expenditure was approximately between 50 and 150 % higher (depending on age group) among people in the lowest educational and income levels. These differences generally disappeared or decreased after including health covariates in the analyses. After adjustment for health, socioeconomic differences in total healthcare expenditure were reduced by 74–91 %. Conclusions: In this study among Dutch adults, lower socioeconomic status was associated with increased healthcare expenditure and utilization. These socioeconomic differences largely disappeared after taking into account health status, which implies that, within the universal Dutch healthcare system, resources are being spent where they are most needed. Improving health among lower socioeconomic groups may contribute to decreasing health inequalities and healthcare spending.enginfo:eu-repo/semantics/openAccessCOSTSEducationHealthHealthcare expenditureHealthcare utilizationINCOMEINEQUALITIESIncomePOPULATIONSERVICESSocioeconomic statusSDG 3 - Good Health and Well-beingSDG 10 - Reduced InequalitiesArticleGeneral rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. - Users may download and print one copy of any publication from the public portal for the purpose of private study or research. - You may not further distribute the material or use it for any profit-making activity or commercial gain - You may freely distribute the URL identifying the publication in the public portal" Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.https://www.scopus.com/pages/publications/85110882546open57826351143570917https://research.tilburguniversity.edu/en/publications/a739cca2-0eb2-41c7-81d7-761b2ed834cahttps://creativecommons.org/licenses/by/4.0/(c) Universiteit van TilburgLoef, BetteMeulman, IrisHerber, Gerrie-cor M.Kommer, Geert JanKoopmanschap, Marc A.Kunst, Anton E.Polder, Johan J.Wong, AlbertUiters, Ellen