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

Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage

BACKGROUND

Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC.

METHODS

Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition.

RESULTS

In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities.

CONCLUSIONS

The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.

Financial burden of medicines in five Northern European countries: A decommodification perspective

Affordable access to healthcare including medicines is a key social policy goal in Europe. However, it has rarely been addressed in comparative social policy research. Although the concept of decommodification has already been used in the context of healthcare and sickness benefits, we argue that the scope of such studies should be expanded to medicines to understand how welfare states protect their citizens from market forces in case of illness. We examine and compare the relationship between income, other characteristics, and subjective financial burden of medicines (FBM) across five countries with universal health systems pursuing egalitarian aims (Denmark, Finland, the Netherlands, Norway and Sweden). Analyses using 2017 EU-SILC microdata and linear probability models showed large differences in the level of FBM across countries, with the highest income quintile in Finland reporting FBM more frequently than the lowest income quintile in Denmark. Finland differed from the rest by increasing probability of FBM with age. In other countries, middle-aged adults tended to be the most affected, and older adults were well-protected. The association between income and FBM was strongest in the Netherlands; however, the higher probability of FBM was skewed towards the lower quintiles in all countries. FBM and financial burden of medical care were strongly associated although FBM tended to be more common. Unmet needs for medical examination were rare and lacked sensitivity in capturing manifestations of market risk. Decommodification literature has focused healthcare services as proxy of access; nevertheless, our study shows that further functions, and broader outcomes should be examined to capture market risk. Our evidence further highlights that important differences can be found even in countries with relatively similar health policy aims. The cost of medicines should be considered in comparative studies of health and welfare states.

The associations of physical incapacity and wealth with remaining in paid employment after age 60 in five middle-income and high-income countries

Previous studies on health and socioeconomic determinants of later-life labour force participation have mainly come from high-income European countries and the United States of America (USA). Findings vary between studies due to different measures of socioeconomic status and labour force outcomes. This study investigated longitudinal associations of physical incapacity and wealth with remaining in paid employment after age 60 in middle- and high-income countries. Using harmonised cohort data in the USA, England, Japan, Mexico and China (N=32,132), multilevel logistic regression was applied for main associations. The age-related probabilities of remaining in paid employment by physical incapacity and wealth were estimated using marginal effects. This study found that physical incapacity predicted lower odds of remaining in paid employment in each country. Wealth was associated with higher odds of remaining in paid employment in the USA, England, and Japan, but not in Mexico. Probabilities of remaining in paid employment were high in Mexico but low in China. The absolute difference in the probability of remaining in paid employment between the richest and the poorest groups was greater in the USA than that in any other country. In the USA, England and Japan, the inverse association between physical incapacity and remaining in paid employment could be partially compensated by wealth only when physical incapacity was not severe. National policies, including considering older adults' changing capacities for job placement and prioritising the provision of supportive services for socioeconomically disadvantaged older adults, developing pathways for informal workers to access social security and pension coverage, and encouraging employers to hire socioeconomically disadvantaged older workers and enhancing their employability, could be facilitated. Future studies, such as exploring health and socioeconomic determinants of remaining in part-time and full-time paid employment separately in more countries, and the moderating effects of relevant policies on these associations, are needed.

Unmet Health Care Needs of the Older Population in European Countries Based on Indicators Available in the Eurostat Database

Access to healthcare may affect the health of the population, especially older people. The aim of this study is to analyze the reasons and factors influencing the unmet healthcare needs (UHCN) of the older population in the context of differences between age groups for 28 European countries. A self-reported UHCN indicator obtained from Eurostat database was used. The share of people with healthcare needs reporting distance/transportation issues was significantly different in the younger and older groups, as well as in age groups within the older population. The differences in other reasons were not so considerable. Problems with UHCN were observed more often in the older population with lower rather than with higher income and with more severe activity limitations rather than with none/moderate limitations (differences statistically significant, except for income for 75+). In most countries, the UHCN dependence on income/activity limitation is higher in the age group of 15-64 than for the older population. To plan/introduce/monitor appropriate, tailored actions for improving healthcare access for the older population, a detailed analysis of the UHCN prevalence, reasons, and determinants in this age group is needed; it is insufficient to analyze only the population as a whole. Additionally, the group of older people is not homogeneous in terms of UHCN.

Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013-2020

BACKGROUND

In Finland, austerity measures included an increase in medication and healthcare copayments and a decrease in many social security allowances. This study examines whether austerity coincided with an increase in socioeconomic inequality in access to medications (going short of medications because of lack of money) and whether medication access problems increased more than other forms of economic hardship (going short of food or physician visits).

METHODS

Pooled cross-sectional population surveys collected in 2013-2015, 2018 and 2020 (n=139 324) and multinomial logistic regression, with interaction between study year and economic activity (EA) (full-time work vs part-time work/retirement; old age retirement; unemployment; disability/illness; family; student), were used to estimate the effect of EA on the probability of experiencing economic hardship (no hardship/hardship including medication problems/hardship excluding medication problems) and how it varies across years.

RESULTS

Working-age adults outside full-time employment have a higher risk of economic hardship than full-time workers, and old age retirees have a lower risk. In 2018, when austerity was most pronounced, economic hardship including medication problems increased for the disabled/ill (women and men), unemployed (women) and part-time workers/retirees (men), significantly more than for full-time workers. Hardship excluding medication access problems either decreased or remained unchanged.

CONCLUSION

Austerity coincided with increasing economic hardship among vulnerable groups, thus exacerbating socioeconomic inequalities. Strengthening the role for medication access problems suggests that medication copayment increases contributed to this accumulating disadvantage.

Life expectancy at 65, associated factors for women and men in Europe

In Europe, the epidemiological transition has already taken place, while the demographic transition continues. Life expectancy at 65 is expanding for both women and men. The primary aim of this work is to identify the factors associated with life expectancy at 65 for women and men in Europe. The second aim is to confirm the influence of cultural factors on life expectancy. Finally, the link between spending on pensions, soil pollution, and life expectancy is also tested. Data for 31 European countries for the period 2004-2018 have been collected to estimate a linear panel data model. Life expectancy at 65 for women and men is the dependent variable. Independent variables are grouped into socioeconomic, cultural, and environmental conditions. The main result of this work is the importance of GDP per capita, and education and pension expenditure in explaining the heterogeneity of life expectancy at 65 across countries. Other significant results include the association of cultural characteristics, air pollution, and soil pollution with life expectancy. The design of policies for older adults and the improvement of their health and active life should consider not only differences in education but cultural characteristics, too. European directives that disregard people's cultural differences may not have the expected result.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00695-1.

Suicide among Older People in Different European Welfare Regimes: Does Economic (in)Security Have Implications for Suicide Prevention?

Older adult suicide rates vary widely within Europe, and differential welfare policies might contribute to this. We studied variations in economic indicators and suicide rates of people 65+ across 28 European countries and examined the effects of these indicators on suicide rates, grouping countries according to their socio-political systems and welfare regimes. Suicide data was obtained from the WHO European Mortality Database. The European Union Statistics on Income and Living Conditions and the European Union Labour Force Survey provided data on economic indicators. Linear mixed models were applied. Suicide rates ranged from 4.22/100,000 (Cyprus) to 36.37/100,000 (Hungary). Material deprivation was related to elevated suicide rates in both genders in the pooled data set and in men but not women in the Continental and Island countries. Higher ratio of median income (65+/under 65) was associated with lower likelihood of suicide in women in the South-Eastern European countries. In the Nordic region, the 65+ employment rate was associated with a decreased likelihood of suicide in men. These factors to some extent show economic insecurity against older people, which influences the likelihood of suicide. Active labor market policies and inclusive social environment may contribute to suicide prevention in this age group.

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg

OBJECTIVES

We investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need.

DESIGN

Cross-sectional survey conducted between February and December 2014.

SETTING AND PARTICIPANTS

4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over.

OUTCOME MEASURES

Six binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care.

RESULTS

The most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles.

CONCLUSIONS

Recent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.

Factors affecting unmet healthcare needs of low-income overweight and obese women in Korea: analysis of the Korean National Health and Nutrition Examination Survey 2017

Purpose

The purpose of this study was to explore unmet healthcare needs among low-income overweight and obese women and to identify the factors affecting unmet healthcare needs.

Methods

The study was a secondary analysis of data from the 2017 Korea National Health and Nutrition Examination Survey. A final sample of 388 out of 8,127 participants was analyzed using complex descriptive statistics, the chi-square test, the independent t-test, and logistic regression.

Results

The mean age of the participants was 66.51±1.05 years. Unmet healthcare needs were experienced by 19.4% of low-income overweight and obese women. Women with depression, stress, and poor self-reported health status were significantly more likely than their counterparts to experience unmet healthcare needs. Poor self-reported health status was confirmed to be related to unmet health needs in low-income overweight and obese women (odds ratio, 2.65; p=.011).

Conclusion

The study provides the novel insight that the unmet healthcare needs of low-income overweight and obese women were influenced by self-reported health status. Healthcare providers should make efforts to develop strategies to reduce unmet healthcare needs among low-income overweight and obese women, who constitute a vulnerable population.

The impact of a co-payment increase on the consumption of type 2 antidiabetics - A nationwide interrupted time series analysis

International literature suggests that co-payment increases are associated with decreased medicine use, although the effects depend on context. We examined the impact of a co-payment increase on the consumption of type 2 antidiabetics in Finland, a country with a comprehensive health and social security system including ceiling mechanisms aiming to protect patients from high co-payment expenditures. We used administrative register data on all reimbursed purchases of antidiabetics during 2014-2018. An interrupted time series design with segmented regression was used to examine the mean monthly purchase per person, measured as Defined Daily Doses (DDDs), before and after the co-payment increase. At baseline, the mean monthly purchase per person of type 2 antidiabetics was 105 DDDs (95% CI 103.8; 106.0;p<0.001) and there was a decreasing trend of 0.2 DDDs per month (95% CI -0.23;-0.13;p<0.001). A statistically significant decrease of 5.6 DDDs (95% CI -7.3;-3.8;p<0.001) was detected after the reform; however, no significant change in the trend was observed. No significant increase was detected in the mean monthly per person purchase of insulins. The results suggest that a co-payment increase decreases consumption of necessary medicines despite the presence of a medicine co-payment ceiling mechanism. Whether the decrease was associated with negative health effects remains to be further investigated.

The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study

Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients' pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences estimation, we analyze whether the reform increased the use of social assistance, a last-resort financial aid. We found that after the reform the share of social assistance recipients increased more among type 2 diabetes patients than among a patient group not affected by the co-payment increase, suggesting the reform increased the use of social assistance among those subject to it. The results indicate that increases in patients' pharmaceutical expenses can lead to serious financial difficulties even in countries with a comprehensive social security system.

Effects of Interactive Videogames on Postural Control and Risk of Fall Outcomes in Frail and Pre-frail Older Adults: A Systematic Review and Meta-Analysis

Background: Interactive videogames (IVGs) have been used to reduce risk of falls in the older adult and improve postural control (PC) outcomes. Objective: To systematically review trials that examine whether IVGs training is effective in improving PC and managing falls in frail and pre-frail older adults. Data Sources: Four databases were searched, Scopus, Web of science, PubMed, and MEDLINE, from January 2007 to March 2019. Eligibility Criteria: Frail and pre-frail older adults aged 65+. Interventions were any Nintendo^® Wii™ training. The outcome measures were PC and risk of falls as measured by any validated outcome measure. Studies Appraisal Method: The PEDro (Physiotherapy Evidence Database) scale and Cochrane risk-of-bias tool were used by two independent authors. Results: Eleven papers were included, involving 388 participants, with a mean age of 79 ± 5.7 years. The mean duration of IVGs sessions was 8.8 ± 3.8 weeks, the mean total number of sessions was 20 ± 11.1 session, and the mean length of training was 44 ± 15.7 minutes. Meta-Analysis: IVGs achieved better results compared with traditional exercises and control on the Berg Balance Scale (mean difference [MD] 2.80; 95% confidence interval [CI] 1.21 to 4.39; P < 0.001; I² = 16%), as well as in the short term on Timed Up and Go (MD -1.23; 95% CI -2.37 to -0.09; P = 0.03; I² = 0%). Limitation: Definitive judgement could not be made due to the variability in training, training duration and outcomes measurement. Conclusion: IVGs is a promising modality that has a positive effect on PC but not on the outcome of falls, so it should be prescribed with caution among frail older adults. Systematic Review Registration: PROSPERO registration number: CRD42019129611.

A New Perspective of Urban-Rural Differences: The Impact of Social Support on the Mental Health of the Older Adults: A Case from Shaanxi Province, China

With the increase in aging in China, the health problems of older adults, especially mental health problems, have become a concern for the whole society. This article selected urban and rural older adults and analyzed the impact of social support on their mental health using a binary logistic model. It was found that under the current urban–rural dichotomy, the effects of social support on the mental health of urban and rural older adults are significantly different. In social support, first, the fairness and satisfaction with the social security system only had a significant effect on the mental health of urban older adults and had no significant effect on the rural older adults. Second, the closeness of contact with grassroots community workers had a significant impact on the mental health of older adults in urban and rural areas. From informal social support, the mental health of rural older adults was mainly influenced by the support of their children, reflecting the influence of the traditional culture of “filial piety”. Furthermore, the mental health of urban older adults was mainly influenced by neighborhood support, reflecting the importance of “close neighbors are better than distant relatives”. Based on the results of the empirical study, this article suggests that to promote the mental health of older adults, we should start by strengthening the formal social support system, establishing high-quality community service facilities, and emphasizing the role of informal social support.

Influencing Factors of Undermet Care Needs of the Chinese Disabled Oldest Old People When Their Children Are Both Caregivers and Older People: A Cross-Sectional Study

We examined the influencing factors of the undermet care needs of the Chinese disabled oldest old people when their children are both caregivers and are themselves older people. Data were obtained from a cross-sectional survey: the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. The study participants included 1617 disabled oldest old people whose primary caregiver were their children or children-in-law and were aged 60 years and over. The results showed that the prevalence of undermet needs remained high, with 49.6% disabled oldest old people reporting undermet care needs. Binary logistic regression analysis revealed that living in a rural area (OR = 1.309, 95% CI = 1.133-1.513) and a higher frailty index (OR = 1.103, 95% CI = 1.075-1.131) were significantly positively associated with higher odds for undermet care needs, while a higher annual household income (OR = 0.856, 95% CI = 0.795-0.923), more financial support from children (OR = 0.969, 95% CI = 0.941-0.997), higher care expenditures (OR = 1.044, 95% CI = 1.002-1.088), better caregiver's performance (OR = 0.282, 95% CI = 0.196-0.407) and sufficient income to pay for daily expenses (OR = 0.710, 95% CI = 0.519-0.973) were significantly inversely associated with higher odds for undermet care needs. This evidence suggests the importance of policies to establish a community-based socialized long-term care system and supporting family caregivers of the disabled oldest old people.

The geography and economics of forgoing medical examinations or therapeutic treatments in Italy during the economic crisis

Background

In Italy, the number of individuals who have forgone medical examinations or treatments for economic reasons is one of the highest in Europe. During the global economic crisis of 2008, the restrictive policies concerning access to healthcare and the quality of these services, which differs widely throughout the country, may have accentuated the territorial differences in unmet needs, thereby penalizing the more disadvantaged segments of the population.

The study aimed at evaluating the geographical and socioeconomic differences, in particular the risk of poverty, that influence forgoing healthcare services in Italy.

Methods

Cross-sectional Italian data from the 2004–2015 European Survey on Income and Living Conditions (EU-SILC) were used.

Hierarchical logistic models were tested, using as the outcome unmet needs for medical examinations or treatment in the preceding 12 months, and as risk factor the condition of being at risk of poverty. Age, sex, citizenship, educational level, presence of chronic or severely limiting diseases and self-perceived health were used as adjustment factors. Analyses were stratified over three time periods: pre-crisis (2004–2007), initial phase of the crisis (2008–2012) and second phase of the crisis (2013–2015).

Results

In Central Italy and particularly in Southern Italy, a marked increase (9.9% in 2013–2015) was seen in the overall rate of unmet needs as well as in that of unmet needs due to economic reasons. The probability of unmet needs was higher, and increased over time, for those at risk of poverty (aOR = 1.54 in 2004–07, aOR = 1.70 in 2008–12, aOR = 2.21 in 2013–15). Individuals with a low educational level, who had a chronic or severely limiting disease, who perceived their health as not good and immigrants had a higher risk of forgoing healthcare. The regions in Southern Italy had a significantly higher probability of unmet needs.

Conclusions

A strong association was found between the probability of forgoing medical examination or treatment and being at risk of poverty. Study results underline the need for healthcare policies aimed at facilitating access to healthcare services, particularly in the South, by developing a progressive mechanism of contribution to healthcare costs proportional to income and by guaranteeing free access to the poor.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7502-x) contains supplementary material, which is available to authorized users.

Medical expenditures and its determinants depending on receipt of public pension in South Korea

BACKGROUND

The objective of this study was to analyze the expenditures on medical expenses and its determinants using the Korean Retirement and Income Data conducted by the National Pension Research Institute.

METHODS

This study utilized data from the Korean Retirement and Income Study from 2005 to 2013, which were compiled by the National Pension Research Institute. The t test and ANOVA were used to analyze the general characteristics and medical expenditures of subjects depending on the receipt of public pension, and logistic regression was used to identify the determinants of medical expenditures.

RESULTS

The results of this study indicated that households not receiving public pension are likely to spend more on medical expenses than those receiving public pension. The analysis results showed that gross household expenditures quintiles affected medical expenditures up to 4 times. Moreover, poor physical health was a stronger influence factor of medical expenditures than good physical health.

CONCLUSION

It is necessary to prepare a pension policy that can guarantee a reasonable amount of a retirement pension to the retiree, provide health policy and financial support programs to medical services.

Can inequalities in political participation explain health inequalities?

Inequalities in health are pervasive and durable, but they are not uniform. To date, however, the drivers of these between-country patters in health inequalities remain largely unknown. In this analysis, we draw on data from 17 European countries to explore whether inequalities in political participation, that is, inequalities in voting by educational attainment, are correlated with health inequalities. Over and above a range of relevant confounders, such as GDP, income inequality, health spending, social protection spending, poverty rates, and smoking, greater inequalities in political participation remain correlated with higher health inequalities. If 'politicians and officials are under no compulsion to pay much heed to classes and groups of citizens that do not vote' then political inequalities could indirectly affect health through its impact on policy choices that determine who has access to the resources necessary for a healthy life. Inequalities in political participation, then, may well be one of the 'causes of the causes' of ill-health.

Analysis of the Effect of the Elderly's Labor Status on Care Cost at the End of Life

This study quantitatively analyzes the effects of employment patterns at the time of death of the elderly on the utilization of medical care before death using the cohort data from the National Health Insurance Corporation, controlling mortality to obtain more accurate results. Gender was coded as 0 for males and 1 for females, and average monthly household income was taken as a logarithm to approximate a normal distribution. Care cost at the end of life was defined as the sum of the national health insurance contributions and statutory self-contributions. To measure proximity to death, deceased elderly were divided by the period from last hospital visit to death (except any hospital visit at time of death). We distinguished regular workers, irregular workers, self-employed and employers, unpaid family workers, and unemployed. The data used in this study are sample cohort data from the National Health Insurance Corporation. We examined the relationships between variables through 4 models using negative binomial regression. The effects of employment status on health status were analyzed and adjusted for demographic characteristics, socioeconomic status, and proximity to death. As the dependent variable, medical expenses were taken for 1 year before death. In this study, care costs at end of life were higher when children were economically independent and when the respondent was more educated, had high economic level, and had high average monthly household income. In addition, employment security also had a significant impact on care cost at end of life: Irregular workers spent significantly less than regular workers. The fact that care cost at end of life is differentiated according to employment status suggests that individuals’ health exists within a social context, which may also constrain it: There is a risk that people’s health status will become determined by socioeconomic status.

Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea

Objectives

The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated.

Methods

Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables.

Results

The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model.

Conclusions

The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.

The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis

Background

Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship.

Methods

We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU.

Results

Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022–0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications.

Conclusions

Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health.

Family transfers and long-term care: An analysis of the WHO Study on global AGEing and adult health (SAGE)

BACKGROUND

Populations globally are ageing, resulting in increased need for long-term care. Where social welfare systems are insufficient, these costs may fall to other family members. We set out to estimate the association between long-term care needs and family transfers in selected low- and middle- income countries.

METHODS

We used data from the World Health Organization's Study on global AGEing and adult health (SAGE). Using regression, we analysed the relationship between long-term care needs in older households and i) odds of receiving net positive transfers from family outside the household and ii) the amount of transfer received, controlling for relevant socio-demographic characteristics.

RESULTS

The proportion of household members requiring long-term care was significantly associated with receiving net positive transfers in China (OR: 1.76; p = 0.023), Ghana (OR: 2.79; p = 0.073), Russia (OR: 3.50; p < 0.001). There was a statistically significant association with amount of transfer received only in Mexico (B: 541.62; p = 0.010).

CONCLUSION

In selected LMICs, receiving family transfers is common among older households, and associated with requiring long-term care. Further research is needed to better understand drivers of observed associations and identify ways in which financial protection of older adults' long-term care needs can be improved.