[Social Inequalities in Access to and Utilization of Medical Rehabilitation - Results of the Third German Sociomedical Panel of Employees (GSPE-III)].

Aim Of The Study: The influence of social status on health is well documented. Preliminary research provides initial evidence for social inequalities in rehabilitation care. Our study examines the role of social inequalities with respect to access and utilisation of medical rehabilitation services by analysing a risk cohort of the German Statutory Pension Insurance Scheme (Deutsche Rentenversicherung Bund).

Methods: Data for the analysis consists of questionnaire data from the first two waves of the Third German Socio-medical Panel of Employees (GSPE-III) and administrative data of participants (2013-2016). This risk cohort comprises 40-54-year-old employees receiving sickness benefits in 2012. Using logistic regression models, the application for medical rehabilitation, its approval and rejection, possible opposition proceedings and its subsequent utilisation were analysed. The social status was measured by an index as well as by the single dimension of education. The analyses were carried out separately by gender. Age, employment status and subjective health status were considered as covariates.

Results: A total of 2.376 insured employees, 1.092 men and 1.284 women, were included in the analysis. 639 (26.9%) submitted at least one application for medical rehabilitation. The chance of submitting an application was higher for men with low socioeconomic status (OR=1.8; 95%-CI=1.3-2.5) or lower (OR=1.9; 95%-CI=1.3-2.8) and medium education (OR=1.5; 95%-CI=1.1-2.2) in relation to the high status or education group. For women, low education (OR=1.6; 95%-CI=1.1-2.5) raised the chances of an application. When adjusted for health status and current employment situation, all significant differences disappeared. Regarding approval and utilisation, there were no significant differences between socioeconomic status groups, but women with a medium level of education were significantly more likely to have their application approved on the basis of an opposition proceeding (OR=3.0; 95%-CI=1.1-8.2) than women with a high level of education.

Conclusion: The analyses provided no evidence of a socially unequal access to or utilization of medical rehabilitation. However, insured persons with a low social status more frequently applied for rehabilitation, especially because of their poorer subjective health. Further research is needed to ensure that this meets the objective needs of this status group.