The development of healthcare use among a cohort of Finnish social assistance clients: testing the social selection hypothesis.

This article examines the association between healthcare use and receipt of social assistance. It focuses on asking to what extent the use of healthcare (seen as a proxy for health status) leads to social assistance. This is answered by describing the use of healthcare services among a cohort of Finnish social assistance clients before, during and after the first receipt of benefit by means of fixed-effects logistic regression. Using register data, the study follows a group of social assistance recipients from 2005 to 2011 and compares their use of healthcare to those not claiming social assistance during this same period and analyses how their use of health services develops over time. The results show that recipients use public healthcare clearly more than non-recipients, but they do so already prior to the first social assistance receipt. This partly confirms the social selection hypothesis according to which health problems lead to low income. However, the results do not exclude the existence of social causation. The causality is most likely bi-directional. The findings of the descriptive analyses are corroborated by a fixed-effects logistic regression analysis: the use of healthcare services increases the probability of receiving social assistance in the following month.