Inequity in unmet medical need among the European elderly

This study evaluates unfair inequality, namely inequality of opportunity (IOp), in access to medical care among the elderly population. I compare the magnitude of IOp across 14 European countries using data from the Survey of Health, Aging and Retirement in Europe (SHARE) collected in 2013. Self-reported unmet medical need caused by cost-related reasons is used as a measure of medical access. Separate models are introduced to accommodate two competing philosophical views (e.g. control and preference approaches) that result in a different definition of the scope of individual responsibility. A joint estimation strategy is applied to take unobserved heterogeneity into account. We find the highest IOp to exist in medical access in EE and IT, and the lowest in AT, CH, SI, NL, SE and DK. However, some results are sensitive to normative assumptions. For instance, EE, IT and DE show greater IOp when it is assumed that individuals are responsible for their decisions made on the basis of genuine preference rather than control. Additional results from a policy simulation suggest that IOp could have been significantly reduced due to educational promotion in many countries, with the exception of EE, NL, SI, SE and DK.