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

Income inequality and foregone medical care in Europe during The Great Recession: multilevel analyses of EU-SILC surveys 2008–2013 - Download this document for free, or read online. Document in PDF available to download.

International Journal for Equity in Health

, 15:101

Economic crisis in Europe and Equity in Health


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.

KeywordsAccess to healthcare Economic crisis Income inequality Equity in health  Download fulltext PDF

Author: Jon Ivar Elstad


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