Income inequality and foregone medical care in Europe during The Great Recession: multilevel analyses of EU-SILC surveys 2008–2013

Abstract

BackgroundThe association between income inequality and societal performance has been intensely debated in recent decades. This paper reports how unmet need for medical care has changed in Europe during The Great Recession, and investigates whether countries with smaller income differences have been more successful than inegalitarian countries in protecting access to medical care during an economic crisis.MethodsSix waves of EU-SILC surveys (2008—2013) from 30 European countries were analyzed. Foregone medical care, defined as self-reported unmet need for medical care due to costs, waiting lists, or travel difficulties, was examined among respondents aged 30–59 years (N = 1.24 million). Countries’ macro-economic situation was measured by Real Gross Domestic Product (GDP) per capita. The S80/S20 ratio indicated the country’s level of income inequality. Equity issues were highlighted by separate analyses of disadvantaged respondents with limited economic resources and relatively poor health. Cross-tabulations and multilevel linear probability regression models were utilized.ResultsForegone medical care increased 2008—2013 in the majority of the 30 countries, especially among the disadvantaged parts of the population. For the disadvantaged, unmet need for medical care tended to be higher in countries with larger income inequalities, regardless of the average economic standard in terms of GDP per capita. Both for disadvantaged and for other parts of the samples, a decline in GDP had more severe effects on access in inegalitarian countries than in countries with less income inequality.ConclusionsDuring The Great Recession, unmet need for medical care increased in Europe, and social inequalities in foregone medical care widened. Overall, countries with a more egalitarian income distribution have been more able to protect their populations, and especially disadvantaged groups, against deteriorated access to medical care when the country is confronted with an economic crisis.

Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need

“…According to Reeves, McKee [25], more than 1.5 million additional people have reported unmet healthcare needs since the beginning of the financial and economic crisis. This reversing trend can be explained by the onset of the financial and economic crisis and the related introduction of austerity measures in several European countries [17, 26], especially in countries with a large income inequality [26]. Reeves, McKee [25] identified demand-side factors (e.g., increasing co-payments, rising transport costs and reduced incomes) and supply-side factors (e.g., closing times of health facilities and reduction in opening hours) as potential mechanisms underlying this evolution.…”

No unmet needs without needs! Assessing the role of social capital using data from European social survey 2014

“…Previous findings are mixed in this regard. In [20], higher education decreased probability of unmet needs, while in [18], a negative relationship between tertiary education and probability of unmet needs for dental care was found and a positive relationship in the case of medical care. The authors suggest that more educated individuals have, on average, greater time constraints which may lead them to postpone medical visits or treatments.…”

“…Various empirical papers have focused on unmet healthcare needs, however, to our knowledge, few studies performed analyses at the European level. These studies were based on data from the European Statistics on Income and Living Conditions (EU-SILC) [17][18][19][20] and on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), though in this latter case only five European countries were included in the analysis [21]. Our study takes advantage of the data collected within the rotating module on 'Social Inequalities in Health' of the European Social Surveyround 7 (ESS7), exploring its richness regarding information associated with social capital, for a large set of European countries.…”

“…Similarly to previous studies [5,[17][18][19][20][21][22], to measure unmet needs, we resort on the question: "In the last 12 months, were you ever unable to get a medical consultation or the treatment you needed for any of the reasons listed on this card?". Those who answer 'Yes' are immediately classified as the ones with unmet healthcare needs.…”

29 recommendations to combat social inequalities in health. The Norwegian Council on Social Inequalities in Health

“…• Strengthen tobacco and alcohol policies with measures targeting price and availability Health services that reduce social differences in health (38,39,40,41,42,43,44)…”