Unravelling socioeconomic and regional differences in health and healthcare expenditures in the Netherlands: the contribution of loneliness, income inadequacy and mastery

Although health has generally improved, not everyone has benefited equally. How is it possible that health in one region is better or worse than in another? Explanations are often sought in demographic characteristics (such as age) and socio-economic characteristics (such as income and education). However, these factors alone do not explain health inequalities. This dissertation shows that other characteristics are also of added value, such as loneliness, income inadequacy and mastery. After including these factors, regional differences in mental health and total healthcare costs can be explained. There is one exception: general practitioner (GP) costs in South Limburg remained higher than in all other Dutch regions. This difference with the rest of the Netherlands cannot be fully explained by the aforementioned factors. According to GPs in South Limburg, the mine closures still play an important role in explaining this inequality. Many people became unemployed at the time and there was no proper social safety net. Although social services have improved over time, GPs still notice an overrepresentation of people with problems, for example, low health literacy or psychological distress. This requires both policymakers and practitioners to work across domains, with a focus on preventing poor health and tackling health inequalities.