The effect of employment status and household composition on health care utilisation in a general practice.

OBJECTIVE: to investigate the effect of employment status and family composition on general practice and secondary health care utilisation rates of a New Zealand general practice population. METHODS: the study practice's health care records were electronically interrogated and pooled data on utilisation rates was obtained for a 12 month period. Individual records were grouped according to the number of people in the family and families were further categorised according to the employment status of the adults in the family. Comparisons were made between family groups in rates of general practice and secondary care activities. Costs were attributed to each activity and a cost analysis undertaken. RESULTS: families of four or more people depending on government benefits had a lower primary care cost per person than equivalent families where an adult was in paid employment, but higher costs in secondary care resulted in a higher total health care cost. Overall, for the year reviewed, the mean cost per person for public health care was $365 for people in families where at least one person was in the paid workforce, $568 for those in families depending on government support, and $1438 for people over 60 years of age. CONCLUSION: in this practice the increased use of secondary care facilities by those who have lower rates of general practice activity resulted in a higher overall cost of health care to those patients. This study indicates the need for further analyses of activities by differing patient groupings to facilitate rational and equitable health care planning.