More input from the individual into the management of their health has the potential to reduce demand on the formal care system and improve health outcomes. A variety of interventions have been developed to encourage such ‘self-care', particularly for populations with long-term conditions. However the equity consequences of such initiatives are relatively unknown as there is little evidence on the social and economic determinants of time spent on self-care.
Key methods
We estimate the social and economic determinants of time spent on self-care. We also examine whether patients spend time on self-care because they are compensating for lack of access to formal health care. We undertook regression analyses of eight self-care and formal care measures from a dedicated survey of 300 patients with long-term conditions.
Main results
We found that higher income is associated with less time spent on self-care. Various measures of access to formal health care are found to not be associated with time spent on self-care.
Main conclusion
People from a lower socioeconomic position spend more time managing their condition even when there is universal entitlement to health care.
Rogers A, Bury M and Kennedy A. Rationality, rhetoric, and religiosity in health care: the case of England’s expert patients programme. Int J Health Serv 2009; 39: 725–747.
Lorig KR, Sobel DS, Stewart AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999; 37: 5–14.
11.
Richardson G, Kennedy A, Reeves D, et al. Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions. J Epidemiol Community Health 2008; 62: 361–367.
12.
JowseyTYenLPaulMW. Time spent on health related activities associated with chronic illness: a scoping literature review. BMC Public Health2012; 12: 1044–1044.
13.
YenLMcRaeISJowseyT. Health work by older people with chronic illness: how much time does it take?Chronic Illn2013; 9: 268–282.
14.
EttnerSLCadwellBLRussellLB. Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?Health Econ2009; 18: 645–663.
15.
CoffeyRM. The effect of time price on the demand for medical-care services. J Hum Resour1983; 18: 407–424.
16.
GrossmanM. On the concept of health capital and the demand for health. J Polit Econ1972; 80: 223–255.
17.
CulyerAJWagstaffA. Equity and equality in health and health care. J Health Econ1993; 12: 431–457.
18.
MorrisSSuttonMGravelleH. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med 19822005; 60: 1251–1266.
19.
Van DoorslaerEMasseriaCKoolmanX. Inequalities in access to medical care by income in developed countries. CMAJ Can Med Assoc J2006; 174: 177–183.
20.
ContoyannisPJonesAM. Socio-economic status, health and lifestyle. J Health Econ2004; 23: 965–995.
21.
LynchJWKaplanGASalonenJT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med1997; 44: 809–819.
22.
VassilevIRogersABlickemC. Social networks, the ‘work’ and work force of chronic illness self-management: a survey analysis of personal communities. PloS One2013; 8: e59723–e59723.
23.
RogersABrooksHVassilevI. Why less may be more: a mixed methods study of the work and relatedness of ‘weak ties’ in supporting long-term condition self-management. Implement Sci2014; 9: 19–19.
Vallejo-TorresLMorrisS. Factors associated with the use of primary care services: the role of practice nurses. Eur J Health Econ HEPAC Health Econ Prev Care2011; 12: 373–381.
32.
WagnerEH. Chronic disease management: what will it take to improve care for chronic illness?Eff Clin Pract ECP1998; 1: 2–4.
33.
Panagioti M, Richardson G, Small N, et al. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2014; 14: 356. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177163/ (accessed 4 August 2015).
34.
McIntyreDThiedeMBirchS. Access as a policy-relevant concept in low- and middle-income countries. Health Econ Policy Law2009; 4: 179–193.
35.
Blickem C, Kennedy A, Vassilev I, et al. Linking people with long-term health conditions to healthy community activities: development of Patient-Led Assessment for Network Support (PLANS). Health Expect Int J Public Particip Health Care Health Policy 2013; 16: e48–59.
