Access to healthcare for people aged 50+ in Europe during the COVID-19 outbreak

Abstract

This paper combines SHARE Corona Survey and SHARE Wave 7 data for 25 European countries and Israel ( N = 40,919) with institutional and epidemic-related country characteristics to investigate healthcare access for Europeans aged 50+ during the outbreak of COVID-19. We use a micro–macro approach to examine whether and to what extent barriers to accessing healthcare measured by reported unmet healthcare needs vary within and between countries. We consider various aspects of barriers and distinguish among: (1) respondents who forewent medical treatment because they were afraid of becoming infected with the Coronavirus; (2) respondents who had pre-scheduled medical appointments postponed by health providers due to the outbreak; and (3) respondents who tried to arrange a medical appointment but were denied one. Limited access to healthcare during the initial outbreak was more common for the occupationally active, women, the more educated and those living in urban areas. A bad economic situation, poor overall health and higher healthcare utilisation were robust predictors of unmet healthcare. People aged 50+ in countries of ‘Old’ Europe, countries with higher universal health coverage and stricter containment and closure policies were more likely to have medical services postponed. Policymakers should address the healthcare needs of older people with chronic health conditions and a poor socio-economic status who were made more vulnerable by this pandemic. In the aftermath of the health crisis, public health systems might experience a great revival in healthcare demand, a challenge that should be mitigated by careful planning and provision of healthcare services.

COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe?

“…The percentage of unmet needs due to denied medical appointments is notably lower than that due to postponed care. The between-country variation is also reduced, as it has been observed in previous studies [26,27].…”

“…We have used information from wave 7 for all those variables not collected in wave 8 (e.g., area of residence) and we have updated the baseline information collected in wave 7 for the rest of the variables included in the analyses (e.g., chronic conditions or job situation). The same procedure is followed by Smolic et al [26] or Arnault et al [27].…”

“…However, the evidence on the evolution of income-related inequalities and equity in health care during the COVID-19 pandemic is still scarce, and only refers to the United Kingdom [25]. Furthermore, only a couple of studies analysed the determinants of unmet needs during the COVID-19 outbreak for European older people [26,27]. Unlike our paper, these studies neither provide information disaggregated by countries, nor calculate inequity in unmet need.…”

Effect of the COVID-19 Pandemic on Cost-Related Prescription Nonredemption, Health care Seeking and Hospitalization in Hungary: A Nationally Representative Cross-Sectional Study

“…This gap has been significantly narrowed during the pandemic period, suggesting that elective interventions were mainly postponed. These Hungarian observations are not in line with the independence between education and health care use during the pandemic, as described in the EU [29] and in the Netherlands [50], but these results were similar to the main findings of the SHARE Corona Survey on 27 European countries' 50+ year-old population [45]. Furthermore, our investigation demonstrated the inverse relationship of CRPNR with education, which was exaggerated in the pandemic period.…”

“…Data analysis demonstrated a profound pandemic decrease in the GP visit frequency, specialist visit frequency, and hospital admission rate (by 23.2%, 26.4%, and 6.7%, respectively) but not in the occurrence of CRPNR when comparing the prepandemic and pandemic situations. According to publications about the use of specific health care facilities [10,28,[42][43][44][45] or on general health care access [45,46], there was wide variability across European countries, and the Hungarian findings corresponded to the average of the European observations. Hungary's prepandemic CRPNR was within the range of published references from developed countries [47].…”