Socioeconomic inequity in access to care among older people in Japan

Abstract

Objectives To assess the socioeconomic inequity in access to medical and long-term care (LTC). Methods We used data from Wave 6 (2002) through Wave 10 (2021) of the National Survey of the Japanese Elderly to assess gradients by income and education in access to medical care and LTC among Japanese individuals aged 60 years and above. Specifically, we assessed self-reported unmet needs for medical care and LTC, and public LTC use, and estimated the concentration indices (CI) to measure the degree of inequality and inequity. We standardised public LTC use by need and non-need variables. We analysed data derived from up to 1,775 person-wave observations from 1,370 individuals. Results The pooled incidence across waves of forgone medical care, self-reported unmet support for activities of daily living (ADL) or instrumental ADL (IADL), and those not certified for LTC services even with ADL or IADL limitations were 4.6%, 15.5%, and 62.5%, respectively. Public LTC use demonstrated pro-higher education and pro-rich distribution, whereas the gaps decreased for need-predicted use. Based on the CI estimates, no explicit inequality was found for forgone medical care. However, we observed inequity in standardised LTC use across education, indicating pro-higher education inequality, particularly among women and those aged ≥80 years. Conclusions Improving the understanding of available resources and strengthening the functions of health centres and communities are required to detect the needs of citizens and facilitate their access to necessary care.