Socioeconomic differences in healthcare expenditure and utilization in The Netherlands

Bette Loef*, Iris Meulman, Gerrie Cor M. Herber, Geert Jan Kommer, Marc A. Koopmanschap, Anton E. Center, Johan J. Polder, Albert Wong, Ellen Uiters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)
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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.

Original languageEnglish
Article number643
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 3 Jul 2021

Bibliographical note

Funding Information:
This study was funded by the Strategic Program project “Zorgkloof” of the Dutch National Institute for Public Health and the Environment (RIVM). The funding source had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the articles; and in the decision to submit it for publication.

Publisher Copyright:
© 2021, The Author(s).


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