Unmet health care needs among the working-age population: Evidence from the Great Recession in Spain (2008-2012)
DOI:
https://doi.org/10.23938/ASSN.1093Keywords:
Health care, Unmet needs, Spain, Discrete choice models, Employment.Abstract
Background. This study examines the relationship between unmet healthcare needs and employment status, with a focus on how this relationship was influenced by the Spanish economic recession of 2008-2012.
Methods. Data were obtained from the Spanish National Health Survey for 2006 and 2011-2012. The outcome variable was the presence of unmet healthcare needs, describing its reasons. The analysis included the period (pre-crisis/crisis), demographic variables (sex, age, Spanish citizenship), employment status, social factors (level of education, marital status, social-class), and health indicators (self-assessed health, chronic conditions, and limitations). Logistic regression was used to predict unmet health needs based on the period, employment status, and control variables.
Results. The frequency of unmet healthcare needs was low and decreased further during the crisis (5% pre-crisis vs 3% during the crisis). Unmet healthcare needs were more strongly associated with health status than with employment status. However, among the unemployed, unmet healthcare needs increased during the crisis compared to the pre-crisis.
Conclusions. The most vulnerable groups, characterized by higher unmet healthcare needs, included women, individuals with lower levels of education, and those in poorer health. These groups may require more targeted attention. These findings should be interpreted in the context of the Spanish National Health System, which is fully decentralized and provides healthcare and protection to all residents.
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BLÁZQUEZ-FERNÁNDEZ C, CANTARERO-PRIETO D, PEREZ-GONZALEZ P, LLORCA-DÍAZ J. Does early-life health enhance growth? Evidence from Spain. Appl Econ Lett 2015; 22(11): 860-864. https://doi.org/10.1080/13504851.2014.982851
ALLIN S, MASSERIA C. Research Note: Unmet need as an indicator of access to health care in Europe. The London School of Economics and Political Science, 2009. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=c5a2f79ff01396a7e4affa9540a29ae71c83ac0d
ALLIN S, MASSERIA C. Unmet need as an indicator of health care access. Eurohealth 2009; 15(3): 7-9.
DETOLLENAERE J, HANSSENS L, VYNCKE V, DE MAESENEER J, WILLEMS S. Do we reap what we sow? Exploring the association between the strength of European primary healthcare systems and inequity in unmet need. PloS One 2017; 12(1): e0169274. https://doi.org/10.1371/journal.pone.0169274
STRONKS K, VAN DE MHEEN H, VAN DEN BOS J, MACKENBACH JP. The interrelationship between income, health and employment status. Int J Epidemiol 1997; 26(3): 592-600. https://doi.org/10.1093/ije/26.3.592
HUANG J, BIRKENMAIER J, KIM Y. Job loss and unmet health care needs in the economic recession: different associations by family income. Am J Public Health 2014; 104(11): e178-e183. https://doi.org/10.2105/AJPH.2014.301998
ROTAROU ES, SAKELLARIOU D. Access to health care in an age of austerity: disabled people’s unmet needs in Greece. Critical Public Health 2019; 29(1): 48-60. https://doi.org/10.1080/09581596.2017.1394575
LEE SY, KIM CW, KANG JH, SEO NK. Unmet healthcare needs depending on employment status. Health Policy 2015; 119(7): 899-906. https://doi.org/10.1016/j.healthpol.2014.09.007
MADUREIRA-LIMA J, REEVES A, CLAIR A, STUCKLER D. 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 2018; 47, (1): 58-68. https://doi.org/10.1093/ije/dyx193
CÓRDOBA-DOÑA JA, ESCOLAR-PUJOLAR A, SAN SEBASTIÁN M, GUSTAFSSON PE. How are the employed and unemployed affected by the economic crisis in Spain? Educational inequalities, life conditions and mental health in a context of high unemployment. BMC Public Health 2016; 16: 1-11. https://doi.org/10.1186/s12889-016-2934-z
LOPEZ-VALCARCEL BG, BARBER P. Economic crisis, austerity policies, health and fairness: Lessons learned in Spain. Appl Health Econ Health Policy 2017; 15(1): 13-21. https://doi.org/10.1007/s40258-016-0263-0
DAVIS BS, MCWHIRTER MF, GORDON DS. Where needs and demands diverge: health promotion in primary care. Public Health 1996; 110(2): 95-101. https://doi.org/10.1016/S0033-3506(96)80053-9
CAVALIERI M. Geographical variation of unmet medical needs in Italy: a multivariate logistic regression analysis. Int J Health Geogr 2013; 12: 1-11. https://doi.org/10.1186/1476-072X-12-27
CHAUPAIN-GUILLOT S, GUILLOT O. Health system characteristics and unmet care needs in Europe: an analysis based on EU-SILC data. Eur J Health Econ 2015; 16(7): 781-796. https://doi.org/10.1007/s10198-014-0629-x
JANG Y, PARK NS, YOON H, HUANG YC, RHEE MK, CHIRIBOGA DA et al. The risk typology of healthcare access and its association with unmet healthcare needs in Asian Americans. Health Soc Care Comm 2018; 26(1): 72-79. https://doi.org/10.1111/hsc.12463
QUINTAL C, LOURENÇO Ó, RAMOS LM, ANTUNES M. No unmet needs without needs! Assessing the role of social capital using data from European Social Survey 2014. Health Policy 2019; 123(8): 747-755. https://doi.org/10.1016/j.healthpol.2019.06.001
RAMOS LM, QUINTAL C, LOURENÇO Ó, ANTUNES M. Unmet needs across Europe: disclosing knowledge beyond the ordinary measure. Health Policy 2019; 123(12): 1155-1162. https://doi.org/10.1016/j.healthpol.2019.09.013
MORAN V, SUHRCKE M, RUIZ-CASTELL M, BARRÉ J, HUIART, L. Investigating unmet need for healthcare using the European health interview survey: A cross-sectional survey study of Luxembourg. BMJ Open 2021; 11(8): e048860. https://doi.org/10.1136/bmjopen-2021-048860
QUINTAL C, RAMOS LM. ANTUNES M, LOURENÇO Ó. Unmet healthcare needs among the population aged 50+ and their association with health outcomes during the COVID-19 pandemic. Eur J Ageing 2023; 20(1): 12. https://doi.org/10.1007/s10433-023-00758-x
FERNÁNDEZ SC, AJURIA AF, MARTÍN JJ, MURPHY MJ. The impact of the economic crisis on unmet dental care needs in Spain. J Epidemiol Community Health 2015; 69(9): 880-885. https://doi.org/10.1136/jech-2014-204493
GARCÍA-GÓMEZ P, HERNÁNDEZ-QUEVEDO C, JIMÉNEZ-RUBIO D, OLIVA-MORENO J. Inequity in long-term care use and unmet need: two sides of the same coin. J Health Econ 2015; 39: 147-158. https://doi.org/10.1016/j.jhealeco.2014.11.004
OLIVA MORENO J, GONZÁLEZ LÓPEZ-VALCÁRCEL B, BARBER PÉREZ P, PEÑA LONGOBARDO LM, URBANOS GARRIDO R, ZOZAYA GONZÁLEZ N. Crisis económica y salud en España. 2019. Madrid: Ministerio de Sanidad, Consumo y Bienestar Social Centro de Publicaciones, 2019. https://www.sanidad.gob.es/estadEstudios/estadisticas/docs/CRISIS_ECONOMICA_Y_SALUD.pdf
URBANOS-GARRIDO RM. Income-related inequalities in unmet dental care needs in Spain: traces left by the Great Recession. Int J Equity Health 2020; 19: 1-13. https://doi.org/10.1186/s12939-020-01317-x
MORENO A, LOSTAO L, BELLER J, SPERLICH S, RONDA E, GEYER S et al. Trends and equity in the use of health services in Spain and Germany around austerity in Europe. Int J Equity Health 2021; 20(1): 120. https://doi.org/10.1186/s12939-021-01459-6
GUSTAVSSON E. From needs to health care needs. Health Care Anal 2014; 22(1): 22-35. https://doi.org/10.1007/s10728-013-0241-8
ÁLVAREZ-GÁLVEZ J, RODERO-COSANO ML, SALINAS-PÉREZ JA, GÓMEZ-BAYA D. Exploring the complex associations among social determinants of health in Andalusia after the 2008 financial crisis. Soc Indic Res 2019; 141(2): 873-893. https://doi.org/10.1007/s11205-018-1845-z
JONES AM, RICE N, D'UVA TB, BALIA, S. Applied health economics. 2nd Edition. London: Routledge, 2013.
DEB P, NORTON EC, MANNING WG. Health econometrics using STATA. Texas: Stata Press, 2017.
DE MATTEIS D, ISHIZAKA A, RESCE G. The ‘postcode lottery’ of the Italian public health bill analysed with the hierarchy stochastic multiobjective acceptability analysis. Socio Econ Plan Sci 2019; 68: 100603. https://doi.org/10.1016/j.seps.2017.12.001
DAVILLAS A, JONES AM. Unmet health care need and income‐Related horizontal equity in use of health care during the COVID‐19 pandemic. Health Econ 2021; 30(7): 1711-1716. https://doi.org/10.1002/hec.4282
LÓPEZ-CASASNOVAS G. The Spanish economic crisis and its consequences on social spending. SESPAS report 2014. Gac Sanit 2014; 28: 18-23. https://doi.org/10.1016/j.gaceta.2014.02.020
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