Abstract
BackgroundUnmet 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.MethodsWe 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.ResultsJob 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.ConclusionsUnemployment 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.
Highlights
The declining trend in unmet medical need (UMN) in Europe suffered a reversal at the onset of the Great Recession in 2008 as more people began reporting that they were foregoing care because it was too expensive.[1,2] In response to the crisis some governments increased co-payments for some services and treatments, but these changes were implemented some time after the crisis, suggesting that this initial rise may be explained by declining incomes.Incomes fall due to unemployment and, in many European economies, the unemployed may have limited access to healthcare
In order to optimize the research design possibilities offered by the employment status data collected yearly from the same individual in the longitudinal arm and the access to health care data in the cross-sectional arm, we produced a pseudopanel for Unmet medical need (UMN)
The coefficient for the simple bivariate association between unemployment and UMN is b 1⁄4 0.027 [95% confidence interval (CI) 0.022–0.033: P < 0.001), or, if 1000 people lost their jobs, approximately 27 would lose access to health care
Summary
The declining trend in unmet medical need (UMN) in Europe suffered a reversal at the onset of the Great Recession in 2008 as more people began reporting that they were foregoing care because it was too expensive.[1,2] In response to the crisis some governments increased co-payments for some services and treatments, but these changes were implemented some time after the crisis, suggesting that this initial rise may be explained by declining incomes.Incomes fall due to unemployment and, in many European economies, the unemployed may have limited access to healthcare. 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. 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 [b 1⁄4 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. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health
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