Inequity in long-term care use and unmet need: Two sides of the same coin

Abstract

International studies have shown evidence on inequity in use of health services of different kinds, depending on the type of health care service analysed. However, equity in the access to long-term care (LTC) services has received much less attention. We investigate the determinants of several LTC services and the existence of unmet need by the disabled population using unique data from a survey conducted on the disabled population in Spain in 2008. We further measure the level of horizontal inequity using methods based on the Concentration Index, a widely used indicator of income-related inequality in health. At the time of the analysis, only those respondents with the highest dependency level were covered by the recently introduced universal LTC system, which allows us to explore whether inequities remain for this subgroup of the population. In addition, we compare results using self-reported versus a more objective indicator of unmet needs. Evidence suggests that after controlling for a wide set of need variables, there is not an equitable distribution of use and unmet need of LTC services in Spain, with socioeconomic status being an important factor in access to LTC. We find that individuals at the higher end of the income distribution utilize a relatively larger share of formal services (provided by a professional), while intensive informal care (provided by friends and family) is concentrated among the worst-off. In terms of unmet needs for LTC services, their distribution depends on the service considered as well as on whether we focus on subjective or objective measures. Interestingly, for the population covered by the new universal LTC system, inequities in most LTC services and unmet needs remain statistically significant and even increase for certain services, in particular, formal services provided by professionals. JEL classification codes: I14, 138, J14

Perceptions of unmet needs for community social care services in England. A comparison of working carers and the people they care for

“…Research using data from a large‐scale survey conducted on the disabled population in Spain in 2008 found unmet need for long‐term care is higher for those with both higher subjective and ADL‐based measures of need (García‐Gómez et al . ).…”

“…This is consistent with previous research (Van der Roest et al 2009) which found that perceived unmet needs for services were higher for those providing unpaid care for someone with higher level of disability, although that study used different measures of disabilityseverity of dementiaand was carried out in the Netherlands. Research using data from a large-scale survey conducted on the disabled population in Spain in 2008 found unmet need for long-term care is higher for those with both higher subjective and ADL-based measures of need (Garc ıa-G omez et al 2014).…”

Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data

“…Only four papers have specifically investigated horizontal inequity in LTC use by socioeconomic status. García‐Gómez, Hernández‐Quevedo, Jiménez‐Rubio, and Oliva‐Moreno () find pro‐rich horizontal inequity among the elderly in Spain in 2008, that is, before public support for the disabled elderly was expanded. Exploiting the SHARE survey, Ilinca, Rodrigues, and Schmidt () and Rodrigues, Ilinca, and Schmidt () find that formal home care use is roughly proportionately distributed across income in most European countries.…”

Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals

“…The consequences of forgone care can be manifold, including a disease's progression, a higher use of emergency departments, "feeling worried" and/or problems with daily activities [4,5]. Persons reporting forgone care can be divided into two groups: group (I) persons who perceive a need for health care, which would be confirmed by a health professional (subjective and objective need) and group (II) persons who perceive a need for health care, but which would not be confirmed by a health professional (subjective but not objective need) (Table 1) [6,7]. While both kinds of forgone care are of high relevance for the respective individuals, for health care providers and, eventually, for the health care system, the distinction between these two groups needs to be considered carefully when interpreting data and/or trying to develop strategies to reduce forgone care.…”