Department of Public Health and Primary Health Care, Ghent University, C. Heymanslaan 10 (6K3), B-9000, Ghent, Belgium.
KU Leuven, Research Centre for Economics (ECON), Warmoesberg 26, B-1000, Brussels, Belgium.
Int J Equity Health. 2021 Mar 16;20(1):79. doi: 10.1186/s12939-021-01412-7.
The Great Recession, starting in 2008, was characterized by an overall reduction in living standards. This pushed several governments across Europe to restrict expenditures, also in the area of healthcare. These austerity measures are known to have affected access to healthcare, probably unevenly among social groups. This study examines the unequal effects of retrenchment in healthcare expenditures on access to medical care for different income groups across European countries.
Using data of two waves (2008 and 2014) of the European Union Statistics of Income and Living Conditions survey (EU-SILC), a difference-in-differences (DD) approach was used to analyse the overall change in unmet medical needs over time within and between countries. By adding another interaction, the differences in the effects between income quintiles (difference-in-difference-in-differences: DDD) were estimated. To do so, comparisons between two pairs of a treatment and a control case were made: Iceland versus Sweden, and Ireland versus the United Kingdom. These comparisons are made between countries with recessions equal in magnitude, but with different levels of healthcare cuts. This strategy allows isolating the effect of cuts, net of the severity of the recession.
The DD-estimates show a higher increase of unmet medical needs during the Great Recession in the treatment cases (Iceland vs. Sweden: + 3.24 pp.; Ireland vs. the United Kingdom: + 1.15 pp). The DDD-estimates show different results over the two models. In Iceland, the lowest income groups had a higher increase in unmet medical needs. This was not the case in Ireland, where middle-class groups saw their access to healthcare deteriorate more.
Restrictions on health expenditures during the Great Recession caused an increase in self-reported unmet medical needs. The burden of these effects is not equally distributed; in some cases, the lower-income groups suffer most. The case of Ireland, nevertheless, shows that certain policy measures may relatively spare lower-income groups while affecting middle-class income groups more. These results bring in evidence that policies can reduce and even overshoot the general effect of income inequalities on access to healthcare.
始于 2008 年的大衰退的特点是生活水平整体下降。这促使欧洲多个政府限制支出，包括医疗保健领域。这些紧缩措施被认为影响了医疗保健的可及性，而且在不同社会群体中的影响可能不均衡。本研究考察了医疗保健支出削减对不同收入群体获得医疗服务的不平等影响在欧洲各国的表现。
利用欧盟收入和生活条件调查（EU-SILC）两个时期（2008 年和 2014 年）的数据，采用差异中的差异（DD）方法分析了各国之间和各国内部未满足的医疗需求随时间的总体变化。通过增加另一个交互项，估计了收入五分位数之间的效果差异（差异中的差异中的差异：DDD）。为此，在两个治疗病例和一个对照病例的两组之间进行了比较：冰岛与瑞典，以及爱尔兰与英国。这些比较是在严重程度相同但医疗削减水平不同的衰退国家之间进行的。这种策略可以将削减的影响与衰退的严重程度隔离开来。
DD 估计表明，在大衰退期间，治疗组的未满足医疗需求增加更多（冰岛与瑞典相比：+3.24%；爱尔兰与英国相比：+1.15%）。DDD 估计在两个模型中显示出不同的结果。在冰岛，收入最低的群体未满足的医疗需求增加更多。爱尔兰则并非如此，中产阶级群体的医疗可及性恶化更为明显。
大衰退期间对卫生支出的限制导致自我报告的未满足医疗需求增加。这些影响的负担分配不均；在某些情况下，低收入群体受影响最大。然而，爱尔兰的情况表明，某些政策措施可能相对减轻低收入群体的负担，而对中产阶级收入群体的影响更大。这些结果表明，政策可以减少甚至超过收入不平等对医疗保健可及性的总体影响。
