Income significantly influences the use of healthcare services

People on lower incomes are more likely to suffer from chronic illnesses, go to the doctor more often, use fewer preventive healthcare services, and incur higher costs. This is shown by the new income report prepared by the University of Basel on behalf of Helsana, which is based on insurance and income data. The analysis reveals clear differences between income categories. Here are some examples: 

• The percentage of those affected by depression in the lowest income category is around three times as high as in the highest.
• For elevated cholesterol levels, the difference is 74%.
• People on lower incomes are more than three times as likely to suffer chronic pain, and re-ceive strong painkillers much more often.
• Insured persons on lower incomes have longer hospital stays. 

The difference in the use of medical services is complex, but cannot be explained solely by the state of health. People on lower incomes use more services even if their health circumstances are the same. According to the analysis, healthcare costs for people with a household income of up to CHF 2000 are around CHF 4764 per year. For people with an income of more than CHF 8000, these costs amount to around CHF 3279.

Preventive services are used unevenly

Despite services sometimes being offered free of charge, lower-income households make use of medical check­ups much less frequently than those on higher incomes. This can be seen, for example, in the early detection of bowel cancer: the participation rate is low even in cantons with funded screening programmes; it ranges from as little as 25 to 48%, depending on the canton. As such, participation in preventive services cannot be explained solely by financial factors. Health literacy and information play an important role.

Existing incentives are becoming less effective

The results also show that financial incentives are becoming less effective in the current system. The minimum deductible has remained unchanged at CHF 300 for around 20 years. During this time, average costs have risen significantly, which has reduced the steering effect of the deductible. 

Need for action on incentives and preventive health services

The results indicate a need for structural action. The minimum deductible should be adjusted to restore its effectiveness as a steering mechanism. At the same time, preventive health services must be improved and made accessible to all. Finally, it is important to promote health literacy among the population. The new legal framework in accordance with Art. 56a of the Federal Health Insurance Act (KVG) provides a basis for informing insured persons in a targeted manner about suitable services and preventive measures. This instrument is intended to help reduce incorrect care and coordinate the use of services more effectively.