Socio-economic Aspects of Health-Related Behaviors and Their Dynamics: A Case Study for the Netherlands

Document Type: Original Article

Authors

1 Health Management and Economics Research Center (HMERC), Isfahan University of Medial Sciences, Isfahan, Iran

2 Department of Health Services Research, CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands

3 Top Institute for Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands

Abstract

Background
Previous studies have mostly focused on socio-demographic and health-related determinants of health-related behaviors. Although comprehensive health insurance coverage could discourage individual lifestyle improvement due to the ex-ante moral hazard problem, few studies have examined such effects. This study examines the association of a comprehensive set of factors including socio-demographic, health status, health insurance, and perceived change in health insurance coverage with health-related behaviors and their dynamics (ie, changes in behavior).
 
Methods
Using Survey of Health, Aging, and Retirement in Europe (SHARE) data (a European aging survey among 50+ years old) for the Netherlands in 2004 and 2007 (sample size: 1745), binary and multinomial logit models are employed to study health-related behaviors (daily smoking, excessive alcohol use, and physical inactivity in 2004) and their corresponding changes (stopping or starting unhealthy behavior between 2004 and 2007).
 
Results
Our findings show that being older, being female, having higher education and living with a partner increase the likelihood not to be a daily smoker or to stop daily smoking. At the same time, being older (OR = 3.02 [1.31, 6.95]) and being female (OR = 1.77 [1.05, 2.96]) increases the likelihood to be or to become physically inactive. We also find that worse perceived health insurance coverage in 2007 is associated with a lower likelihood (OR = 0.19 [0.06, 0.57]) of stopping excessive alcohol use in that year. However, we do not find a strong association between the type of health insurance and health behavior.
 
Conclusion
Our findings show that all above mentioned factors (ie, socio-demographic and health status factors) are associated with health-related behavior but not in a consistent way across all behaviors. Moreover, the dynamics of each behavior (positive or negative change) is not necessarily determined by the same factors that determine the state of that behavior. We also find that better perceived health insurance coverage is associated with a healthier lifestyle which is not compatible with an ex-ante moral hazard interpretation. Our results provide input to target policies towards elderly individuals in need of lifestyle change. However, further research should be done to identify the causal effect of health insurance on health-related behavior.

Keywords

Main Subjects


  1. Alwan A. Global status report on noncommunicable diseases 2010. World Health Geneva: Organization; 2011.
  2. Mackenbach J. Health and health care. In: Borsch-Supan A,  Brugiavini A, jurges H, Mackenbach J, Siegrist J, Weber G, eds. Health, ageing and retirement in europe: First results from the survey of health, ageing and retirement in europe. Mannheim, Germany: Mannheim Research Institute for the Economics of Aging (MEA); 2005:81-162.
  3. UN. Res/66/2. Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases (resolutions adopted by the general assembly at its 66th session), 2011.
  4. Harper S, Lynch J. Trends in socioeconomic inequalities in adult health behaviors among us states, 1990–2004. Public Health Rep. 2007;122:177-189.
  5. Newsom JT, Huguet N, McCarthy MJ, et al. Health behavior change following chronic illness in middle and later life. J Gerontol B Psychol Sci Soc Sci. 2012;67B(3):279-288. doi:10.1093/geronb/gbr103
  6. Johnson PB, Richter L. The relationship between smoking, drinking, and adolescents’ self-perceived health and frequency of hospitalization: analyses from the 1997 national household survey on drug abuse. J Adolesc Health. 2002;30(3):175-183. doi:10.1016/s1054-139x(01)00317-2
  7. Shankar A, McMunn A, Steptoe A. Health-related behaviors in older adults: Relationships with socioeconomic status. Am J Prev Med. 2010;38:39-46. doi:10.1016/j.amepre.2009.08.026
  8. Laaksonen M, Prättälä R, Lahelma E. Sociodemographic determinants of multiple unhealthy behaviours. Scand J Public Health. 2003;31:37-43. doi:10.1080/14034940210133915
  9. Nagelhout GE, de Korte-de Boer D, Kunst AE, et al. Trends in socioeconomic inequalities in smoking prevalence, consumption, initiation, and cessation between 2001 and 2008 in the netherlands. Findings from a national population survey. BMC Public Health. 2012;12:303. doi:10.1186/1471-2458-12-303
  10. Hughes MC, Hannon PA, Harris JR, Patrick DL. Health behaviors of employed and insured adults in the united states, 2004-2005. Am J Health Promot. 2010;24(5):315-323. doi:10.4278/ajhp.080603-quan-77
  11. Molander RC, Yonker JA, Krahn DD. Age-related changes in drinking patterns from mid to older age: Results from the wisconsin longitudinal study. Alcoholism: Clinical and Experimental Research. 2010;34(7):1182-1192. doi:10.1111/j.1530-0277.2010.01195.x
  12. Nystedt P. Marital life course events and smoking behaviour in sweden 1980-2000. Soc Sci Med. 2006;62(6):1427-1442. doi:10.1016/j.socscimed.2005.08.009
  13. Cho HJ, Khang YH, Jun HJ, Kawachi I. Marital status and smoking in korea: The influence of gender and age. Soc Sci Med. 2008;66(3):609-619. doi:10.1016/j.socscimed.2007.10.005
  14. Kiecolt-Glaser JK, Newton TL. Marriage and health: His and hers. Psychol Bull. 2001;127:472-503. doi:10.1037//0033-2909.127.4.472
  15. Smith P, Frank J, Mustard C. Trends in educational inequalities in smoking and physical activity in canada: 1974–2005. J Epidemiol Community Health. 2009;63:317-323. doi:10.1136/jech.2008.078204
  16. Stock C, Wille L, Krämer A. Gender-specific health behaviors of german university students predict the interest in campus health promotion. Health Promot Int. 2001;16(2):145-154. doi:10.1093/heapro/16.2.145
  17. Moore AA, Gould R, Reuben DB, et al. Longitudinal patterns and predictors of alcohol consumption in the united states. Am J Public Health. 2005;95(3):458-464. doi:10.2105/ajph.2003.019471
  18. Manderbacka K, Lundberg O, Martikainen P. Do risk factors and health behaviours contribute to self-ratings of health? Soc Sci Med. 1999;48(12):1713-1720. doi:10.1016/s0277-9536(99)00068-4
  19. Dave D, Kaestner R. Health insurance and ex ante moral hazard: Evidence from medicare. Int J Health Care Finance Econ. 2009;9(4):367-390. doi:10.1007/s10754-009-9056-4
  20. Kenkel DS. Prevention. In: Culyer A, Newhouse JP, eds. Handbook of Health Economics. Elsevier: North-Holland; 2000:1676-1720.
  21. Rezayatmand R, Pavlova M, Groot W. The impact of out-of-pocket payments on prevention and health-related lifestyle: A systematic literature review. Eur J Public Health. 2013;23:74-79. doi:10.1093/eurpub/cks034
  22. Clemens SL, Matthews SL, Young AF, Powers JR. Alcohol consumption of australian women: Results from the australian longitudinal study on women's health. Drug Alcohol Rev. 2007;26(5):525-535. doi:10.1080/09595230701499142
  23. Merrick, E.L.; Horgan, C.M.; Hodgkin, D.; Garnick, D.W.; Houghton, S.F.; Panas, L.; Saitz, R.; Blow, F.C. Unhealthy drinking patterns in older adults: Prevalence and associated characteristics. J Am Geriatr Soc. 2008;56(2):214-223. doi:10.1111/j.1532-5415.2007.01539.x
  24. Platt A, Sloan FA, Costanzo P. Alcohol-consumption trajectories and associated characteristics among adults older than age 50. J Stud Alcohol Drugs. 2010;71(2):169-179. doi:10.15288/jsad.2010.71.169
  25. Willemsen MC, Hoogenveen RT, Van Der Lucht F. New smokers and quitters. Eur J Public Health. 2002;12:136-138. doi:10.1093/eurpub/12.2.136
  26. Bergrath E, Pavlova M, Groot W. Attracting health insurance buyers through selective contracting: Results of a discrete-choice experiment among users of hospital services in the netherlands. Risks. 2014;2(2):146-170. doi:10.3390/risks2020146
  27. Leu RE, Fund C. The swiss and dutch health insurance systems: Universal coverage and regulated competitive insurance markets. New York, NY: Commonwealth Fund; 2009.
  28. Survey of health, aging and retirement in Europe (SHARE) website. http://www.share-project.org/. Accessed November 13, 2012.
  29. De Luca G, Peracchi F. Survey response. In: Borsch-Supan A, Brugiavini A, Jurges H, Siegrist J, Weber G, eds. First Results From the Survey of Health, Aging, and Retirement in Europe. Mannheim, Germany: Mannheim Research Institute for the Economics of Aging (MEA); 2005.
  30. Schroder M. Attriton. In: Borsch-Supan A, Brugiavini A, Jurges H, Kapteyn A, Mackenbach J, Siegrist J, Weber G. eds. First Results From the Survey of Health, Ageing and Retirement in Europe (2004-2007): Starting the Longitudinal Dimension. Mannheim, Germany: Mannheim Research Institute for the Economics of Aging (MEA); 2008.
  31. Klevmarken A, Hesselius P, Swensson B. The share sampling procedures and calibrated designs weights. In: Borsch-Supan A, Jurges H, eds. The Survey of Health, Aging, and Retirement in Europe-Methodology. Mannheim, Germany: Mannheim Research Institute for the Economics of Aging (MEA); 2005:28-69.
  32. Jagger C, Gillies C, Cambois E, Van Oyen H, Nusselder W, Robine J-M. The global activity limitation index measured function and disability similarly across european countries. J Clin Epidemiol. 2010;63:892-899. doi:10.1016/j.jclinepi.2009.11.002
  33. Courbage C, Coulon AD. Prevention and private health insurance in the uk. The Geneva Papers on Risk and Insurance Theory. 2004;29:719-727. doi:10.1111/j.1468-0440.2004.00313.x
  34. Schneider U, Zerth J. Improving prevention compliance through appropriate incentives: Theoretical modelling and empirical evidence. Swiss Journal of Economics and Statistics. 2011;147:71-106.
  35. Van Loon AJM, Tijhuis M, Surtees PG, Ormel J. Determinants of smoking status: Cross-sectional data on smoking initiation and cessation. Eur J Public Health. 2005;15:256-261. doi:10.1093/eurpub/cki077
  36. Eng PM, Kawachi I, Fitzmaurice G, Rimm EB. Effects of marital transitions on changes in dietary and other health behaviours in us male health professionals. J Epidemiol Community Health. 2005;59(1):56-62. doi:10.1136/jech.2004.020073
  37. Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med. 2002;22(4):73-107. doi:10.1016/s0749-3797(02)00434-8
  38. Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145-161. doi:10.1177/0022146510395592
  39. Kegler M, Swan D, Alcantara I, Feldman L, Glanz K. The influence of rural home and neighborhood environments on healthy eating, physical activity, and weight. Prev Sci. 2014;15(1):1-11. doi:10.1007/s11121-012-0349-3
  40. Costa-i-Font J, Hernández-Quevedo C, Jiménez-Rubio D. Do income gradients in unhealthy behaviours explain patterns of health inequalities? London: LSE Health; 2012.
  41. Tambor M, Pavlova M, Woch P, Groot W. Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European union countries. Eur J Public Health. 2011;21:585-590. doi:10.1093/eurpub/ckq139