Health-care accessibility in seven countries in eastern Europe: a multinomial logit study of individual unmet medical needs

P.M. Sowa; J.R.G. Butler; L. Connelly; F. Paolucci

doi:10.1016/S0140-6736(13)61389-6

Background The study examines health-care accessibility in eastern Europe through the lens of individual-level unmet needs for examination or treatment. Investigated are the magnitude and nature of access barriers as well as the structure of inequality. Methods Our research covered seven countries: Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, and Slovakia, over the period 2005-09. Logit and multinomial logit models are estimated for each country-year combination to inspect the relation between respondents' socioeconomic characteristics and the probability of reporting unmet medical needs. The dataset based on European Union (EU) Statistics on Income and Living Conditions comprises 574?390 observations. Study design permits the interpretation of findings in absolute and comparative terms and shows the problem dynamics. Findings Health care is most easily accessible in the Czech Republic and Slovakia. Affordability issues and prohibitive waiting times are prevalent in Poland and the Baltic states. Mobility and information represent relatively minor access barriers. The poorest households, the unemployed, working-age cohorts, and women are generally more exposed than the population at large to problems in accessing health care. Through the course of the analysed period, we saw an overall improvement in access conditions. Interpretation The findings show that substantial differences exist between the countries that constitute an arguably homogenous group of post-communist, new EU member states. The best performers are not only the biggest per capita spenders on health, but they also rely on competition in health-care financing. The remaining countries, where the state remains a key player in the health sector, display lower and varying levels of performance. The nature of access barriers is indicative of gaps in coverage and inadequacy of public sector resources relative to need, which call for systemic solutions. In the context of tightening welfare states' belts, reform policies should seek good practices by observing the peer countries' experiences with health-care organisation. Funding Australian National University higher degree by research scholarship.

Health-care accessibility in seven countries in eastern Europe: a multinomial logit study of individual unmet medical needs

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