Inequality in Healthcare Access Across Europe: Patterns and Determinants

Joint Work with Monika Ewa Kaminska (University of Bremen)

This talk investigates patterns and determinants of inequality in healthcare access across Europe. It is based on three related articles at very different stages of completion. Comments and suggestions are highly appreciated!
Article 1 (published in JESP) investigates the outcomes out-of-pocket payments (OOPP) produce in terms of income-related disparities in unmet health needs (UHN) due to inability to pay and highlights the commodifying effect of OOPP in European healthcare systems. It merges micro data from the European Union Statistics on Income and Living Conditions survey (EU-SILC) for 2005–2012, with macro data from the World Bank, Organisation for Economic Co-operation and Development (OECD) and World Health Organization (WHO). Our results show that, first, across all European countries and years under study, income determines whether a person reports an occasion within the last year where she needed medical treatment or examination but did not receive it due to inability to pay. Second, the more a country relies on OOPP as a means of healthcare financing, the higher the proportion of respondents who report UHN. Third, the share of OOPP amplifies the effect of income considerably. While the poorest decile has a 2 percentage points higher predicted probability of suffering from financially determined UHN than the richest decile in a country with relatively low OOPP (11% of total health expenditure), this difference soars up to 10 percentage points in a country with relatively high OOPP (25%).
Article 2 (incomplete draft stage) zooms in on commodification and stratification in Central and Eastern European (CEEC) healthcare systems in the European perspective. The demise of communism forced Central and Eastern European countries (CEECs) to fundamentally reform their ‘premature’ welfare states, including health care (Kornai 1997; Hacker 2009; Rechel/McKee 2009). One of the disturbing outcomes of the reforms is a very high level of unmet health needs in a number CEECs by far exceeding the respective figures in most welfare states in Western Europe. In order to place CEECs in the European context, it maps the relationship between commodification and stratification outcomes at the micro-level and macro-level variables across the EU countries. Here, the paper relies on power resources theory which attributes welfare state policy designs and outcomes to the distribution of power resources in society between major interest groups, the nature and levels of power mobilization, structuration of labour movements and patterns of political coalition-formation. Second, it examines the differences in this relationship from two comparative angles: on the one hand, between the CEECs and Western European countries, and on the other hand, among the ten CEECs.
Article 3 (idea and data collection stage) aims to explain the determinants of out-of-pocket payments (OOPP) in Europe. To our knowledge, there is no or very limited literature explaining OOPP at the macro level, yet it showed to be a dominant factor for healthcare access in our first 2 articles.