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Research shows that patients want better accessibility and continuity

2019-03-28


Research by Petra Persson, Stanford University and IFN, Maria Polyakova and Yiqun Chen, also active at Stanford, shows that people with access to informal health expertise through a family member who works as a doctor or nurse are 10 percent more likely to become 80 years or older. They are also significantly less likely to have chronic lifestyle-related diseases such as heart attacks, heart failure, and diabetes. The study has been published by the National Bureau of Economic Research and also as a working paper at IFN.

You have based the research on Swedish data, why?

Petra Persson: Previous research has documented significant health inequality in large parts of the Western world: individuals with a high socio-economic status live longer and are healthier than their less advantaged counterparts. However, we know less about the mechanisms generating this inequality. One hypothesis that is often discussed in the United States is that health inequality can be explained by unequal access to health insurance. This makes it interesting to study health inequality in Sweden, where everyone has access to health insurance.

We find that inequality in mortality among individuals who are 75 years old - a measure that we can compare in Sweden and the US - is as large in Sweden as in the US. This underscores that it is important to study other factors than health insurance access in generating health inequality. Our study shows that social differences in access to health-related expertise are an important contributing factor to health inequality.

In the research, you see that patients with relatives working within healthcare live longer and are healthier. How can this knowledge be used in healthcare?

Petra Persson: Everyone can of course not have a doctor or nurse in the family, but our results indicate that policy measures that in different ways raise an individual’s access to care have the potential to both improve individual health and to help reduce health inequality. An individual who has a doctor or nurse in the family effectively has continuous access to someone to ask for advice - day and night - and this is a person with a good knowledge of the individual's health history and whom the individual trusts. This points to two important ingredients:

  1. High accessibility
  2. Continuity of care, i.e. the possibility of having long-term contact with the same doctor or nurse.

This is relatively far from the current Swedish model where it can be difficult to get help quickly and where patients often meet different health care providers over time. The latter both makes it difficult to build confidence and reduces the knowledge of the patient's medical history.

Do you see any differences in terms of how this knowledge can be used in practice between the United States and Sweden, as they have very different healthcare systems?

 

Petra Persson: Not directly. Measures that make healthcare more accessible and that make it possible to meet the same health care provider over time can in principle be implemented in both healthcare systems.


Read more: “The Roots of Health Inequality and the Value of Intra-Family Expertise” av Yiqun Chen, Petra Persson och Maria Polyakova. NBER Working Paper nr 25618.

Translation from Swedish to English by Victoria Svensson

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