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J Epidemiol Community Health. 2017 Feb;71(2):174-180. doi: 10.1136/jech-2015-206257. Epub 2016 Dec 13.

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004-2010.

Author information

1
International Inequalities Institute, London School of Economics and Political Science, UK.
2
Department of Sociology, University of Oxford, Oxford, UK.
3
Department of Public Health and Policy, LSHTM, London, UK.
4
Department of Public Health, Erasmus MC, Rotterdam, Netherlands.
5
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.

Abstract

BACKGROUND:

Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe.

METHODS:

We integrated panel data on 16 European countries for years 2004-2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution.

RESULTS:

We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI -0.55 to -1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI -1.19 to -2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=-1.21 percentage points, 95% CI -0.37 to -2.06).

CONCLUSIONS:

Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments.

KEYWORDS:

ACCESS TO HLTH CARE; ELDERLY; POLICY

PMID:
27965315
PMCID:
PMC5284463
DOI:
10.1136/jech-2015-206257
[Indexed for MEDLINE]
Free PMC Article

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