Inequity in healthcare use among older people after 2008: The case of southern European countries

Abstract

Despite the sizeable cuts in public healthcare spending, part of the austerity measures recently undertaken in Southern European countries, little attention has been devoted to monitoring distributional aspects of healthcare usage. This study aims at measuring socioeconomic inequities in primary and secondary healthcare experienced some time after the crisis onset in Italy, Spain and Portugal. The analysis, based on data drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), focuses on older people, who generally face significantly higher healthcare needs, and whose health appeared to have worsened in the aftermath of the crisis. The Horizontal Inequity indexes reveal remarkable socioeconomic inequities in older people's access to secondary healthcare in all three countries. In Portugal, the one country facing most severe healthcare budget cuts and where user charges apply also to GP visits, even access to primary care exhibits a significant pro-rich concentration. If reducing inequities in older people's access to healthcare remains a policy objective, austerity measures maybe pulling the Olive belt countries further away from achieving it.

Income-based inequities in access to mental health services in Canada

“…CIs are increasingly being used to measure inequities in health outcomes and in access to healthcare (Grignon et al 2010;Hosseinpoor et al 2012;Hua et al 2017;Jiménez-Rubio et al 2008;Tavares and Zantomio 2017;Zhang et al 2015). Higher concentrations of mental health problems (measured by CIs) have been found at lower income levels in former Soviet Union countries, the UK, Canada and Australia (Enticott et al 2017;Goryakin et al 2015;Mangalore et al 2007).…”

Receiving Care Through Digital Health Technologies: Drivers and Implications of Old-Age Digital Health Exclusion

“…On the other hand, the lack of availability of services based on digital health technologies in deprived areas (rural, mountain or remote areas) forces older adults to exploit directly administered health care resources, if available, which in turn can mean enduring significant travelling time and stress arising from difficulties in access [see Cholat and Daconto, this section]. Given that older people are one of the main user groups of health services (Tavares and Zantomio 2017) and are more likely to face challenges in accessing and using digital technologies, the growing allocation of resources into digital health provision might be less efficient than expected (Helbig et al 2009). Previous studies found that e-government initiatives failed due to, among others, the limited adoption of the services and the return to the traditional services by many citizens (Janssen et al 2013;Anthopoulos et al 2016).…”

Older People Health and Access to Healthcare: A Retrospective Look at Inequality Dynamics Over the Past Decade

“…Atella et al (2015) also reports preliminary evidence on a sizeable reduction in outpatient care -the component that relies more heavily on private copayments, and was subject to waiting lists extensions due to public budget cutsas of 2012, stronger for among less educated individuals. In facts, as in other Mediterranean countries (Kondilis et al, 2013;Tavares et al, 2017), EU-prompted austerity measures have hit hard Public Healthcare provision, accelerating the implementation of several cost-containment initiatives (see de Belvis et al, 2012 1 , for cost containment measures implementation in Italy). To give a summary figure on the overall effect of such initiatives, a 7% reduction in per-capita public healthcare expenditure in real terms has been registered between 2008 and 2017, even exceeding the corresponding real per capita GDP contraction (6.1%) registered over the same time span.…”

“…Doorslaer and Masseria (2004),Tavares and Zantomio (2017).Instead, the increased HI on specialists' visits requiring out-of-pocket expenditure if not full private payment, in the North, suggest that the average increase in secondary care usage might have arisen only from those in upper part of the income distribution. The role of income in decreasing the probability of GP contacts and increasing the probability of specialist consultation in Italy as already emerged inAtella et al (2004).…”