IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v333y2023ics0277953623004999.html
   My bibliography  Save this article

Social inequality in navigating the healthcare maze: Care trajectories from hospital to home via intermediate care for older people in Norway

Author

Listed:
  • Aimée Hartford Kvæl, Linda
  • Gautun, Heidi

Abstract

Although health inequality is a growing concern, striking differences in health and life expectancy still exist across and within OECD countries. In Oslo, the largest city in Norway, life expectancy differs by up to 7 years between districts. Equal access to healthcare can help reduce social differences in health. However, research indicates that older people at the lower level of the social gradient have more difficulty accessing health services. Older people experience early hospital discharge and several transitions between and across care levels. In this study, using Bourdieu's theory of practice as a theoretical lens, we explore social inequality in access to universal healthcare within care trajectories for older people in Oslo. Through observation of family meetings in intermediate care (N = 14) and semi-structured interviews with older patients (N = 15), informal caregivers (N = 12) and healthcare professionals (N = 18), the study identifies 15 unique care trajectories from hospital to home via intermediate care. Informed by a critical realist perspective and moving from west to east via the urban areas, there is a prominent finding of climbing down the social gradient and, subsequently, reduced access to healthcare. An overarching theme, ‘Navigating the healthcare maze’, was identified along with two subthemes: ‘Individuality meets system’ and ‘Having a feel for the game’. Navigating the healthcare maze depends on where you live, your level of education and health literacy and the ability to mobilize social networks. Furthermore, it is an advantage to fit into the professional habitus of the ‘active patient’ discourse. The findings will be relevant for politicians, managers, healthcare professionals and other stakeholders working in the field and in the development of services adapted to the needs of various socioeconomic groups.

Suggested Citation

  • Aimée Hartford Kvæl, Linda & Gautun, Heidi, 2023. "Social inequality in navigating the healthcare maze: Care trajectories from hospital to home via intermediate care for older people in Norway," Social Science & Medicine, Elsevier, vol. 333(C).
  • Handle: RePEc:eee:socmed:v:333:y:2023:i:c:s0277953623004999
    DOI: 10.1016/j.socscimed.2023.116142
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953623004999
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2023.116142?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Smith, Sian K. & Dixon, Ann & Trevena, Lyndal & Nutbeam, Don & McCaffery, Kirsten J., 2009. "Exploring patient involvement in healthcare decision making across different education and functional health literacy groups," Social Science & Medicine, Elsevier, vol. 69(12), pages 1805-1812, December.
    2. Linda Enroth & Domantas Jasilionis & Laszlo Németh & Bjørn Heine Strand & Insani Tanjung & Louise Sundberg & Stefan Fors & Marja Jylhä & Henrik Brønnum-Hansen, 2022. "Changes in socioeconomic differentials in old age life expectancy in four Nordic countries: the impact of educational expansion and education-specific mortality," European Journal of Ageing, Springer, vol. 19(2), pages 161-173, June.
    3. Terraneo, Marco, 2015. "Inequities in health care utilization by people aged 50+: Evidence from 12 European countries," Social Science & Medicine, Elsevier, vol. 126(C), pages 154-163.
    4. Linda Aimée Hartford Kvæl & Jonas Debesay & Asta Bye & Anne Langaas & Astrid Bergland, 2019. "Choice, Voice, and Coproduction in Intermediate Care: Exploring Geriatric Patients’ and Their Relatives’ Perspectives on Patient Participation," SAGE Open, , vol. 9(3), pages 21582440198, September.
    5. Braveman, Paula & Tarimo, Eleuther, 2002. "Social inequalities in health within countries: not only an issue for affluent nations," Social Science & Medicine, Elsevier, vol. 54(11), pages 1621-1635, June.
    6. Linda Enroth & Domantas Jasilionis & Laszlo Németh & Bjørn Heine Strand & Insani Tanjung & Louise Sundberg & Stefan Fors & Marja Jylhä & Henrik Brønnum-Hansen, 2022. "Correction to: Changes in socioeconomic differentials in old age life expectancy in four Nordic countries: the impact of educational expansion and education-specific mortality," European Journal of Ageing, Springer, vol. 19(4), pages 1643-1644, December.
    7. Tone Alm Andreassen, 2009. "The consumerism of ‘voice’ in Norwegian health policy and its dynamics in the transformation of health services," Public Money & Management, Taylor & Francis Journals, vol. 29(2), pages 117-122, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Paust, Amanda & Lau, Sofie Rosenlund & Bro, Flemming & Prior, Anders & Mygind, Anna, 2023. "Temporal capital and unaligned times as inequality mechanisms: A case study of chronic care in general practice," Social Science & Medicine, Elsevier, vol. 338(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chen, Yuanyuan & Wang, Haining & Cheng, Zhiming & Smyth, Russell, 2023. "Education and Migrant Health in China," Economic Modelling, Elsevier, vol. 121(C).
    2. repec:dau:papers:123456789/13753 is not listed on IDEAS
    3. Ana C. Gómez-Ugarte & Víctor M. García-Guerrero, 2023. "Inequality Crossroads of Mortality: Socioeconomic Disparities in Life Expectancy and Life Span in Mexico Between 1990 and 2015," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-22, August.
    4. Ruth Koops van ‘t Jagt & Shu Ling Tan & John Hoeks & Sophie Spoorenberg & Sijmen A. Reijneveld & Andrea F. de Winter & Sonia Lippke & Carel Jansen, 2019. "Using Photo Stories to Support Doctor-Patient Communication: Evaluating a Communicative Health Literacy Intervention for Older Adults," IJERPH, MDPI, vol. 16(19), pages 1-18, October.
    5. Denzil G. Fiebig & Kees van Gool & Jane Hall & Chunzhou Mu, 2021. "Health care use in response to health shocks: Does socio‐economic status matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3032-3050, December.
    6. Kontos, Emily Z. & Emmons, Karen M. & Puleo, Elaine & Viswanath, K., 2011. "Determinants and beliefs of health information mavens among a lower-socioeconomic position and minority population," Social Science & Medicine, Elsevier, vol. 73(1), pages 22-32, July.
    7. David Cantarero-Prieto & Marta Pascual-Sáez & Carla Blázquez-Fernández, 2021. "Does Social Isolation Affect Medical Doctor Visits? New Evidence Among European Older Adults," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 16(2), pages 787-804, April.
    8. Hafiz Ghulam Mujaddad & Mumtaz Anwar, 2022. "Spatial Analysis of Socioeconomic Inequality of Opportunity in Access to Skilled Birth Attendant in Punjab, Pakistan," Journal of Economic Impact, Science Impact Publishers, vol. 4(1), pages 88-98.
    9. Davillas, Apostolos & Pudney, Stephen, 2020. "Biomarkers, disability and health care demand," Economics & Human Biology, Elsevier, vol. 39(C).
    10. Sabah T Alharbi & Muneeb M Alzghool, 2019. "Factors Associated With Access, Utilization, and Level of Satisfaction With Primary Health Care Services in Hafar Al-batain City of Saudi Arabia," Global Journal of Health Science, Canadian Center of Science and Education, vol. 11(13), pages 1-34, December.
    11. Angela Rauch & Anja Burghardt & Johannes Eggs & Anita Tisch & Silke Tophoven, 2015. "lidA–leben in der Arbeit. German cohort study on work, age and health [lidA–leben in der Arbeit. Kohortenstudie zu Gesundheit und Älterwerden in der Arbeit]," Journal for Labour Market Research, Springer;Institute for Employment Research/ Institut für Arbeitsmarkt- und Berufsforschung (IAB), vol. 48(3), pages 195-202, October.
    12. Fiva, Jon H. & Hægeland, Torbjørn & Rønning, Marte & Syse, Astri, 2014. "Access to treatment and educational inequalities in cancer survival," Journal of Health Economics, Elsevier, vol. 36(C), pages 98-111.
    13. Florence Jusot & Sabine Mage & Marta Menendez, 2014. "Inequality of Opportunity in Health in Indonesia," Working Papers DT/2014/06, DIAL (Développement, Institutions et Mondialisation).
    14. Burhan Can Karahasan & Firat Bilgel, 2017. "Access to Healthcare, Utilization and Health Outcomes in Turkey," Working Papers 1089, Economic Research Forum, revised 04 2017.
    15. Hsieh, Pi-Jung & Lai, Hui-Min, 2020. "Exploring people's intentions to use the health passbook in self-management: An extension of the technology acceptance and health behavior theoretical perspectives in health literacy," Technological Forecasting and Social Change, Elsevier, vol. 161(C).
    16. Raskina, Yulia & Podkorytova, Olga & Kuchakov, Ruslan, 2022. "Health determinants and the reporting heterogeneity bias in Russia: Anchoring vignettes approach," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 66, pages 118-143.
    17. Lucinda Cash-Gibson & Diego F Rojas-Gualdrón & Juan M Pericàs & Joan Benach, 2018. "Inequalities in global health inequalities research: A 50-year bibliometric analysis (1966-2015)," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-22, January.
    18. Chaofan Li & Lei Dou & Haipeng Wang & Shanshan Jing & Aitian Yin, 2017. "Horizontal Inequity in Health Care Utilization among the Middle-Aged and Elderly in China," IJERPH, MDPI, vol. 14(8), pages 1-13, July.
    19. Fahad Riaz Choudhry & Long Chiau Ming & Khadeeja Munawar & Syed Tabish R. Zaidi & Rahul P. Patel & Tahir Mehmood Khan & Shandell Elmer, 2019. "Health Literacy Studies Conducted in Australia: A Scoping Review," IJERPH, MDPI, vol. 16(7), pages 1-32, March.
    20. Marie-Anne Durand & Lewis Carpenter & Hayley Dolan & Paulina Bravo & Mala Mann & Frances Bunn & Glyn Elwyn, 2014. "Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-13, April.
    21. Thomson, Michael, 2019. "Who had access to doctors before and after new universal capitated subsidies in New Zealand?," Health Policy, Elsevier, vol. 123(8), pages 756-764.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:333:y:2023:i:c:s0277953623004999. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.