Unemployment, re-employment and the use of primary health care services

Abstract

Objective: To examine the association between re-employment and the use of primary health care services.

Design: A cohort study of employed teenagers and a 'natural experiment' among adult long-term unemployed with an intervention group of re-employed, a control group of not re-employed, and a matched control group of permanently employed.

Setting: An industrial town (pop. 25,000) in southwestern Finland.

Participants: 84 teenage and 143 adult long-term unemployed and 82 permanently employed individuals.

Main outcome measure: Frequency of primary health care visits.

Results: Primary health care visits increased during re-employment among both teenage and adult re-employed (n = 82), but not in a control group of 61 long-term unemployed who were not employed under the re-employment scheme. A comparison with persons in regular wage employment indicated that visits increased from a low to a normal level.

Conclusion: To explain the results, reference is made to the need for sickness absence certificates and to epidemiological factors. The findings also raise serious questions with regard to the ability of the health care system to reach, let alone help, unemployed citizens.