Li, Keyi; (2024) A broad assessment of the impact of unemployment and fragile employment on health and social care utilisation – evidence from a large, linked dataset from Barking and Dagenham residents in East London. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

BACKGROUND: Unemployment and fragile employment (UFE) have negative impacts on health, but whether and how it affects health and social care utilisation is not clear. Based on a large, linked dataset from Barking and Dagenham, this quantitative thesis aimed to: 1) perform a cross-sectional analysis on the multi-sectoral impact of UFE on health and social care utilisation, assuming ‘no unobserved confounding’; and 2) to explore the longitudinal structure of the data to address unobserved heterogeneity associated with long-term UFE and health and social care utilisation. METHODS: A systematic review with meta-analysis was conducted to gather international evidence on the direction and magnitude of the impact of UFE on health and social care utilisation. Both quantitative studies were based on the Care City dataset linking socio-demographic, health and health care utilisation information of the local residents. In the cross-sectional analysis, bias-corrected matching was employed to quantify the impact of UFE on health costs by primary, hospital, mental health, social and community care. The longitudinal analysis employed fixed effects models to account for potential unobserved heterogeneity between long-term UFE and health and social care utilisation. RESULTS: The literature review suggested that unemployed individuals are more likely to use mental health services, while results in primary care and hospital services were inconclusive. The cross-sectional study found that jobseekers are more likely to use health services across different care settings compared to non-JSA recipients, but differences are relatively modest. The longitudinal analysis suggested that there is no evidence of UFE on health care utilisation after controlling for unobserved heterogeneity. CONCLUSION: The findings of this thesis add to the existing published evidence on the positive impact of both current UFE and long-term UFE on health and social care utilisation across different care settings, under the assumption of ‘no unobserved heterogeneity’. The thesis additionally suggests that the impact of UFE on health care utilisation may be sensitive to potential individual-specific unobserved heterogeneity.

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