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The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis

Madureira-Lima, Joana and Reeves, Aaron and Clair, Amy and Stuckler, David (2018) The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis. International Journal of Epidemiology, 47 (1). pp. 58-68. ISSN 0300-5771

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Identification Number: 10.1093/ije/dyx193

Abstract

Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship. Methods We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU. Results Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022–0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications. Conclusions Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health.

Item Type: Article
Official URL: https://academic.oup.com/ije
Additional Information: © 2017 The Authors
Divisions: Sets > Research centres and groups > International Inequalities Institute
Subjects: H Social Sciences > HB Economic Theory
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Research centres and groups > International Inequalities Institute
Date Deposited: 02 May 2018 12:14
Last Modified: 02 May 2018 12:19
URI: http://eprints.lse.ac.uk/id/eprint/87740

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