Background:
The Great Recession,starting in 2008, was characterized by an overall reduction in living standards. This pushed governmentsacross the European Unionto restrict expenditures, also in the area of healthcare. Theseausterity measures are known to have affectedthe access to healthcare, probably unevenly among social groups.This study examines the unequal effects of cuts in healthcare expenditures on the access to medical carefor differentincome groups across European countries.
Method:
Using data of two waves (2008 and 2014) of the European Union Statistics of Income and Living Conditionssurvey (EU-SILC), a difference-in-differences (DD) approach was used to analyse the overall change in unmet medical needs over time withinand between countries.By adding an additional level thedifferences in the effects between income quintiles (difference-in-difference-in-differences: DDD) were estimated.To do so, three relevant comparisons weremade: Greece versus the other countries, Iceland versus Sweden, and Ireland versus the United Kingdom.The latter two are comparisons of countries with recessions equal in magnitude, but with different levels of healthcare cuts, in order to isolate the effect of these cuts .
Results:
The DD-estimates show a higher increase of unmet medical needs during the Great Recession in Greece comparted with the other countries (+4.15pp). Although this first model gave only a view of the overall effect of the recession, the same but weaker effects were found in the two other models (Iceland vs Sweden: +3.24pp and Ireland vs United Kingdom: +1.15pp).The DDD-estimates shows difference results over the three models. In Greece and Iceland the lowest income groups were most affected, while this was not the case in Ireland.
Conclusion:
Restrictions on health expenditures during the Great Recessioncaused an increase in self-reported unmet medical needs.The burden of these effects is not equally distributed; in most cases the lower income groups suffer most. The case of Ireland, nevertheless, shows that certainpolicy measures may sparelower income groups, whiledisproportionately affecting middle class income groups.These results bring in evidence that policies can reduce and even overshoot the general effect of income inequalities on access to healthcare.