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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Outpatient primary and tertiary healthcare utilisation among public rental housing residents in Singapore

Authors: Jun Jie Benjamin Seng, Vanessa Zi Kun Lim, Yu Heng Kwan, Julian Thumboo, Lian Leng LOW

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Globally, public housing is utilized to provide affordable housing for low-income households. Studies have shown an association between public housing and negative health outcomes. There is paucity of data pertaining to outpatient primary and tertiary healthcare resources utilization among public rental housing residents in Singapore.

Methods

A retrospective cohort study was performed, involving patients under the care of SingHealth Regional Health System (SHRS) in Year 2012. Healthcare utilization outcomes evaluated included number of outpatient primary and specialist care clinic visits, emergency department visits and hospitalization in Year 2011. Multivariate logistical analyses were used to examine the association between public rental housing and healthcare utilization.

Results

Of 147,105 patients, 10,400 (7.1%) patients stayed in public rental housing. There were more elderly (54.8 ± 18.0 vs 49.8 ± 17.1, p < 0.001) and male patients [5279 (50.8%) vs 56,892 (41.6%), p < 0.001] residing in public rental housing. Co-morbidities such as hypertension and hyperlipidemia were more prevalent among public rental housing patients. (p < 0.05).
After adjustment for covariates, public rental housing was not associated with frequent outpatient primary care clinic or specialist outpatient clinic attendances (p > 0.05). However, it was associated with increased number of emergency department visits (OR: 2.41, 95% CI: 2.12–2.74) and frequent hospitalization (OR: 1.56, 95% CI: 1.33–1.83).

Conclusion

Residing in public rental housing was not associated with increased utilization of outpatient healthcare resources despite patients’ higher disease burden and frequency of emergency department visits and hospitalizations. Further research is required to elucidate their health seeking behaviours.
Appendix
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Literature
1.
2.
Shea S, Lima J, Diez-Roux A, Jorgensen NW, McClelland RL. Socioeconomic status and poor health outcome at 10 years of follow-up in the multi-ethnic study of atherosclerosis. PLoS One. 2016;11(11):e0165651.CrossRef
3.
Garrido-Cumbrera M, Borrell C, Palència L, et al. Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system. Int J Health Serv. 2010;40(3):525–42.CrossRef
4.
Habicht J, Kiivet R-A, Habicht T, Kunst AE. Social inequalities in the use of health care services after 8 years of health care reforms–a comparative study of the Baltic countries. Int J Public Health. 2009;54(4):250–9.CrossRef
5.
6.
Low LL, Wah W, Ng MJ, Tan SY, Liu N, Lee KH. Housing as a social determinant of health in Singapore and its association with readmission risk and increased utilization of hospital services. Front Public Health. 2016;4:109.CrossRef
7.
8.
Housing and Development Board. Annual report 2007/2008. Singapore: Housing and Development Board; 2008.
9.
Housing and Developement Board. Annual report 2007/2008. Singapore: Housing and Development Board; 2008.
10.
Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19–31.CrossRef
11.
Fertig AR, Reingold DA. Public housing, health, and health behaviors: is there a connection? J Policy Anal Manage. 2007;26(4):831–60.CrossRef
12.
Seng JJB, Kwan YH, Goh H, Thumboo J, Low LL. Public rental housing and its association with mortality - a retrospective, cohort study. BMC Public Health. 2018;18(1):665.CrossRef
13.
Ferri CP, Acosta D, Guerra M, et al. Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study. PLoS Med. 2012;9(2):e1001179.CrossRef
14.
Regidor E. Social determinants of health: a veil that hides socioeconomic position and its relation with health. J Epidemiol Community Health. 2006;60(10):896–901.CrossRef
15.
Starfield B. Primary care: balancing health needs, services, and technology. Religion in America; 1998.
16.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.CrossRef
17.
Ministry of Health S. Admissions And Outpatient Attendances. In. Singapore 2018.
18.
Gusmano MK. Healthcare financing in Singapore. In: A Singapore bioethics casebook, vol. 2. Singapore: National University of Singapore; 2017.
19.
Ministry of Health S. Healthcare Schemes and Subsidies. In. Singapore 2018.
20.
Chan CQH, Lee KH, Low LL. A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore. Int J Equity Health. 2018;17(1):39.CrossRef
21.
Emmanuel SC, Phua HP, Cheong PY. 2001 survey on primary medical care in Singapore. Singap Med J. 2004;45(5):199–213.
22.
23.
Saxena N, You AX, Zhu Z, et al. Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems. Int J Health Plann Manag. 2017;32(1):36–49.CrossRef
24.
Locker TE, Baston S, Mason SM, Nicholl J. Defining frequent use of an urban emergency department. Emerg Med J. 2007;24(6):398–401.CrossRef
25.
Low LL, Liu N, Wang S, Thumboo J, Ong ME, Lee KH. Predicting frequent hospital admission risk in Singapore: a retrospective cohort study to investigate the impact of comorbidities, acute illness burden and social determinants of health. BMJ Open. 2016;6(10):e012705.CrossRef
26.
Low LL, Tay WY, Ng MJ, Tan SY, Liu N, Lee KH. Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status. Singap Med J. 2018;59(1):39–43.CrossRef
27.
McIsaac W, Goel V, Naylor D. Socio-economic status and visits to physicians by adults in Ontario, Canada. J Health Serv Res Policy. 1997;2(2):94–102.CrossRef
28.
Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med. 2005;60(6):1251–66.CrossRef
29.
Shadmi E, Balicer RD, Kinder K, Abrams C, Weiner JP. Assessing socioeconomic health care utilization inequity in Israel: impact of alternative approaches to morbidity adjustment. BMC Public Health. 2011;11:609.CrossRef
30.
Paduch A, Kuske S, Schiereck T, et al. Psychosocial barriers to healthcare use among individuals with diabetes mellitus: a systematic review. Prim Care Diabetes. 2017;11(6):495–514.CrossRef
31.
Wee LE, Lim LY, Shen T, et al. Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study. Fam Pract. 2014;31(1):81–91.CrossRef
32.
Wee LE, Koh GC. The effect of neighborhood, socioeconomic status and a community-based program on multi-disease health screening in an Asian population: a controlled intervention study. Prev Med. 2011;53(1–2):64–9.CrossRef
33.
Wee LE, Sin D, Cher WQ, et al. “I'm healthy, I don't have pain”- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population. Korean J Pain. 2017;30(1):34–43.CrossRef
34.
Nunes BP, Thume E, Tomasi E, Duro SM, Facchini LA. Socioeconomic inequalities in the access to and quality of health care services. Rev Saude Publica. 2014;48(6):968–76.CrossRef
35.
Moscelli G, Siciliani L, Gutacker N, Cookson R. Socioeconomic inequality of access to healthcare: does choice explain the gradient? J Health Econ. 2018;57:290–314.CrossRef
36.
Ministry of Health S. Waiting times for new appointments at specialist outpatient clinics - cardiology. In: 2018.
37.
Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Soc Sci Med. 2000;51(1):123–33.CrossRef
38.
Gupta D, Denton B. Appointment scheduling in health care: challenges and opportunities. IIE Trans. 2008;40(9):800–19.CrossRef
39.
Salinas-Rodríguez A, Moreno-Tamayo K, Hernández-Serrato M, Enríquez-Rosas MR, Manrique-Espinoza BS. Multidimensional social support is associated with healthcare utilization among older Mexican adults. Eur J Ageing. 2018;15(1):77–85.CrossRef
40.
Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns. 2006;61(3):319–41.CrossRef
41.
Low LL, Kwan YH, Liu N, Jing X, Low ECT, Thumboo J. Evaluation of a practical expert defined approach to patient population segmentation: a case study in Singapore. BMC Health Serv Res. 2017;17(1):771.CrossRef
42.
Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002;92(5):758–68.CrossRef
43.
Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. Jama. 2007;298(14):1685–7.CrossRef
44.
Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310.CrossRef
Metadata
Title
Outpatient primary and tertiary healthcare utilisation among public rental housing residents in Singapore
Authors
Jun Jie Benjamin Seng
Vanessa Zi Kun Lim
Yu Heng Kwan
Julian Thumboo
Lian Leng LOW
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4047-8

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