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



Reeves, A, McKee, M, Mackenbach, J, Whitehead, M ORCID: 0000-0001-5614-6576 and Stuckler, D
(2017) Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004-2010. Journal of Epidemiology and Community Health, 71 (2). pp. 174-180.

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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.

Item Type: Article
Uncontrolled Keywords: Humans, Socioeconomic Factors, Aged, Pensions, Health Services Needs and Demand, Health Services Accessibility, Europe, Female, Male
Depositing User: Symplectic Admin
Date Deposited: 06 Mar 2017 16:01
Last Modified: 19 Jan 2023 07:14
DOI: 10.1136/jech-2015-206257
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3006229