Differential healthcare consumption behavior in French older adults declaring unmet needs population

The objective of this study was to determine the factors associated with declared unmet healthcare needs among older adults aged 65 years or more in the French population, and then to identify the differences in health care expenditures between older adults with and without unmet needs. We used the cross-sectional 2012 French health, health care, and insurance survey (Enquête sur la santé et la protection sociale, ESPS) matched with National Health Insurance data, containing approximately 12000 individual data. We modeled ambulatory health care expenditures using endogenous switching regression, a sequential regression framework, using self-reported unmet needs and ambulatory healthcare expenditures as outcomes, in order to account for any potential bias. In 2012 ESPS database, 1096 elderly individuals (aged at least 65) matching with National Health Insurance data could be identified, with a proportion of individuals with unmet needs of 27.6%. We found that age, smoking status, having a complementary healthcare insurance, income-related characteristics and concern about the future were important determinants of unmet needs. Although we could not identify any significant marginal effect of healthcare unmet needs on healthcare expenditures, we identified different factors associated with expenditures in those with and without unmet needs, especially frailty status. In conclusion, our results brought evidence on a differential behavior with respect to healthcare consumption between older adults with and without unmet needs. Particular focus on prefrail older adults may help to reduce inequalities while considering the high prevalence of prefrail individuals not having sufficient access to meet their healthcare needs. We believe that this new findings would open to a new axis of research to provide more robust evidence to policy-makers.