A new RIVM study has shown that the COVID-19 pandemic intensified existing socio-economic differences. People on lower incomes visited test lanes less often during the pandemic, but were admitted to hospital and intensive care with COVID-19 more often. They were also at a greater risk of dying from the disease.

Some elements of hospital care had to be postponed or cancelled during the COVID-19 pandemic. An earlier RIVM study revealed that more than 300,000 elective operations were cancelled in 2020 and 2021. Examples of elective operations are surgery for cataracts and knee or hip treatments. According to his new study, people on lower incomes were proportionately more likely to have their elective operations cancelled than people on higher incomes. For urgent care, such as surgery following a heart attack, this was not the case, with all such operations going ahead as normal for all income groups. 

Valuation of health and well-being 

Coronavirus prevention measures, such as the closure of schools and limitations on nursing home visits, have consequences for the well-being of the population. Research was carried out into the value people assign to their health and well-being in order to gain an insight into the interaction between the two. The outcome was that people in all socio-economic groups valued well-being three to four times more highly than health. This insight could be used in the future to achieve a better balance between measures that improve health, but have a negative effect on well-being. 


The COVID-19 pandemic made a significant demand of people’s resilience. Over the course of the pandemic, it was notable that people in more well-off socio-economic groups in particular became increasingly used to the situation and confident in their own ability to adapt, making them feel more mentally resilient as a result. By contrast, people in less well-off socio-economic groups increasingly lost their grip on the situation as the pandemic wore on and were mostly reliant on social support networks in their neighbourhood for resilience.

Measures generally supported 

Research was also carried out into what people felt was important when considering supporting the measures introduced by the government. In most cases, Dutch people supported the limitations that the government imposed. At the same time, however, they indicated that they were prepared to comply with the measures only for as long as other people did so, too. Other key considerations were that limitations should not be too strict, that society should remain open as much as possible and that the measures should not change too often. If that happens, some population groups lose trust in the government. 

About the study

This study formed part of a wider research programme. Its objective was to provide building blocks for a social cost-benefit analysis (SCBA) of the COVID-19 pandemic. An SCBA can be a valuable tool for policymakers who need to make choices, particularly when it comes to weighing the consequences for different population groups. 

This RIVM study was conducted in partnership with the Erasmus School of Health Policy & Management (ESHPM), SEO Amsterdam Economics, the Netherlands Bureau for Economic Policy Analysis (CPB) and Wageningen University & Research (WUR).