Socioeconomic Inequality in Unmet Long-Term Care Needs

Europe’s rapidly ageing population poses critical challenges for long-term care (LTC) systems, particularly guaranteeing equitable access. While socio-economic disparities in LTC utilisation are well documented, inequalities in unmet needs—the gap between required and received care—are less studied. Using the 2019 European Health Interview Survey for Spain, we quantify the care gap in hours and classify unmet needs as full, partial, or none. Employing the concentration index, we assess socio-economic inequalities in unmet needs, stratified by eligibility for publicly funded LTC and by limitation severity (number of ADL limitations). We find a pronounced pro-poor concentration of the care gap, disproportionately affecting women, individuals living alone, and the oldest-old. Among individuals below the eligibility threshold, inequality is not statistically significant; however, it becomes substantial among those who are eligible and increases with the severity of limitations. Our decomposition analysis reveals that health status, income, and living arrangement explain most of the observed inequality. Notably, among eligible individuals with more severe ADL limitations, living arrangement emerges as the largest contributor. These results point to the need to reduce inequalities that disproportionally affect those in the bottom socio-economic strata and address disparities through more effective resource allocation and targeted policy interventions. By providing a granular measure of unmet LTC need and its socio-economic determinants, this study contributes to the broader discussion on fairness and efficiency of LTC provision in ageing societies.