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Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004–2010
  1. Aaron Reeves1,2,
  2. Martin McKee3,
  3. Johan Mackenbach4,
  4. Margaret Whitehead5,
  5. David Stuckler2,3
  1. 1International Inequalities Institute, London School of Economics and Political Science, UK
  2. 2Department of Sociology, University of Oxford, Oxford, UK
  3. 3Department of Public Health and Policy, LSHTM, London, UK
  4. 4Department of Public Health, Erasmus MC, Rotterdam, Netherlands
  5. 5Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Aaron Reeves, International Inequalities Institute, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK; a.reeves{at}lse.ac.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.

  • ACCESS TO HLTH CARE
  • POLICY
  • ELDERLY

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/jech-2015-206257

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    Footnotes

    • Contributors AR and DS designed the research, performed the research, wrote the first draft of the paper and analysed the data. AR, DS, JM, MM and MW contributed to the interpretation of the data and writing of the manuscript.

    • Funding This study was undertaken as part of the Demetriq project, funded from the Commission of the European Communities 7th Framework Programme under grant agreement No. 278511. The study does not necessarily reflect the Commission's views and in no way anticipates the Commission's future policy in this area. DS has also received funding from the Wellcome Trust.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.