Expenditure Cuts and Access to Healthcare Under the Great Recession in Europe: Income Groups Are Unequally Affected

Background: The Great Recession, starting in 2008, was characterized by an overall reduction in living standards. This pushed several governments across Europe to restrict expenditures, also in the area of healthcare. These austerity measures are known to have affected access to healthcare, probably unevenly among social groups. This study examines the unequal effects of retrenchment in healthcare expenditures on access to medical care for different income groups across European countries. Method: Using data of two waves (2008 and 2014) of the European Union Statistics of Income and Living Conditions survey (EU-SILC), a difference-in-differences (DD) approach was used to analyse the overall change in unmet medical needs over time within and between countries. By adding another interaction, the differences in the effects between income quintiles (difference-in-difference-in-differences: DDD) were estimated. To do so, comparisons between two pairs of a treatment and a control case were made: Iceland versus Sweden, and Ireland versus the United Kingdom. These comparisons are made between countries with recessions equal in magnitude, but with different levels of healthcare cuts. This strategy allows isolating the effect of cuts, net of the severity of the recession. Results: The DD-estimates show a higher increase of unmet medical needs during the Great Recession in the treatment cases (Iceland vs. Sweden: + 3.24 pp.; Ireland vs. the United Kingdom: + 1.15 pp). The DDD-estimates show different results over the two models. In Iceland, the lowest income groups had a higher increase in unmet medical needs. This was not the case in Ireland, where middle-class groups saw their access to healthcare deteriorate more. Conclusion: Restrictions on health expenditures during the Great Recession caused an increase in self-reported unmet medical needs. The burden of these effects is not equally distributed; in some cases, the lower-income groups suffer most. The case of Ireland, nevertheless, shows that certain policy measures may relatively spare lower-income groups while affecting middle-class income groups more. These results bring in evidence that policies can reduce and even overshoot the general effect of income inequalities on access to healthcare

The unequal effects of austerity measures between income-groups on the access to healthcare : a quasi-experimental approach

Background The Great Recession, starting in 2008, was characterized by an overall reduction in living standards. This pushed several governments across Europe to restrict expenditures, also in the area of healthcare. These austerity measures are known to have affected access to healthcare, probably unevenly among social groups. This study examines the unequal effects of retrenchment in healthcare expenditures on access to medical care for different income groups across European countries. Method Using data of two waves (2008 and 2014) of the European Union Statistics of Income and Living Conditions survey (EU-SILC), a difference-in-differences (DD) approach was used to analyse the overall change in unmet medical needs over time within and between countries. By adding another interaction, the differences in the effects between income quintiles (difference-in-difference-in-differences: DDD) were estimated. To do so, comparisons between two pairs of a treatment and a control case were made: Iceland versus Sweden, and Ireland versus the United Kingdom. These comparisons are made between countries with recessions equal in magnitude, but with different levels of healthcare cuts. This strategy allows isolating the effect of cuts, net of the severity of the recession. Results The DD-estimates show a higher increase of unmet medical needs during the Great Recession in the treatment cases (Iceland vs. Sweden: + 3.24 pp.; Ireland vs. the United Kingdom: + 1.15 pp). The DDD-estimates show different results over the two models. In Iceland, the lowest income groups had a higher increase in unmet medical needs. This was not the case in Ireland, where middle-class groups saw their access to healthcare deteriorate more. Conclusion Restrictions on health expenditures during the Great Recession caused an increase in self-reported unmet medical needs. The burden of these effects is not equally distributed; in some cases, the lower-income groups suffer most. The case of Ireland, nevertheless, shows that certain policy measures may relatively spare lower-income groups while affecting middle-class income groups more. These results bring in evidence that policies can reduce and even overshoot the general effect of income inequalities on access to healthcare

Gender and highbrow cultural participation in Europe : the effect of societal gender equality and development

Existing individual-level research links women's higher participation in high-status cultural activities to their position in work and family spheres. This article studies how cross-national variation in women's and men's cultural participation relates to societal care- and work-related gender equality and development. Multilevel analyses on Eurobarometer data (2013) indicate that male engagement in the feminine domain of care and societal development stimulates frequent participation in highbrow culture, but more for men than for women, thus partly explaining gender gap variation in highbrow cultural participation across European Union countries. We conclude that men play an important but underestimated role in the explanation of the gender gap

Community health workers as a strategy to tackle psychosocial suffering due to physical distancing : a randomized controlled trial

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises

A multilevel perspective on the health effect of social capital : evidence for the relative importance of individual social capital over neighborhood social capital

Employing a multilevel perspective on the health effects of social capital, this study analyzes how individual and neighborhood differences in self-rated health in Ghent (Belgium), relate to individual and collective social mechanisms, when taking demographic and socioeconomic characteristics of individuals into account. This study estimates the health effects of social trust, informal social control and disorder at the neighborhood level and social support and network size at the individual level, using indicators indebted to both the normative and resource-based approaches to social capital. Instead of the mere aggregation of individual indicators of social capital, this study uses the key informant technique as a methodologically superior measurement of neighborhood social capital, which combined with a multilevel analysis strategy, allows to disentangle the health effects of individual and neighborhood social capital. The analysis highlights the health benefits of individual social capital, i.e., individual social support and network size. The study indicates that controlling for individual demographic and socioeconomic characteristics reduces the effect of the neighborhood-level counterparts and the neighborhood characteristics social trust and neighborhood disorder have significant, but small health effects. In its effects on self-rated health, social capital operates on the individual level, rather than the neighborhood level

Overkwalificatie en sociale stress: de invloed van scholing en overkwalificatie op depressie

Op basis van de multilevel-analyse van data van de derde ronde van de European Social Survey (2006) (n=11.545) gaat deze studie in op de invloed van opleidingsniveau en overkwalificatie op symptomen van depressiviteit. Aangeleerde effectiviteit wordt opgenomen als mediator van deze relaties. Deze bijdrage is zo één van de eerste sociologische studies die bestudeert of en hoe overeducatie een effect heeft op de mentale gezondheid. Uit de resultaten blijkt dat overgekwalificeerde werknemers meer symptomen van depressiviteit rapporteren dan werknemers die niet overgekwalificeerd zijn. Tertiair opgeleiden vertonen minder symptomen van depressiviteit dan personen die geen tertiair diploma hebben. Aangeleerde effectiviteit medieert beide relaties. Deze studie gaat in tegen het ‘educatie als fundamentele oorzaak’-paradigma. Hoewel aanhangers er (impliciet of expliciet) van uitgaan dat educatie enkel positieve gevolgen voor de mentale gezondheid heeft, zijn de grotere prevalentie van overkwalificatie bij hooggeschoolden en de negatieve effecten van overeducatie op de mentale gezondheid hiermee in strijd

Overkwalificatie en sociale stress: een kwantitatief onderzoek naar de invloed van scholing en overkwalificatie op depressie

Using multilevel analysis of data of the third wave of the European Social Survey (2006) (n=11.545), this contribution is one of the first sociological studies to address the question if and how overeducation affects mental health. The effects of educational level and overqualification on symptoms of depression are investigated. Learned effectiveness is considered as a mediator of these relations. This study shows that overqualified respondents report higher levels of depressive symptoms. Respondents with a tertiary level of education report less depressive symptoms than those without advanced education. Learned effectiveness mediates the effects of education and overeducation on depression. This study has consequences for the ‘education as fundamental cause’-paradigm. The higher prevalence of overeducation among the highly educated and the negative consequences of overqualification on mental health are in contradiction with the (implicit or explicit) assumption that education has uniformly positive effects on mental health

Structural gender inequalities and the gender gap in highbrow cultural consumption: a cross-national comparative perspective

One of the most consistent findings in the empirical study of cultural consumption is that women participate more often in highbrow cultural activities than men. In the 1980s, Randall Collins claimed that women’s higher rate of highbrow cultural consumption is related to the gendered division of labor: women are in charge of the status production and cultural reproduction within the household and men provide economic resources (i.e. class production) in the workplace. However, not only individual-level differences, but also macro-level gender inequalities in the organization of production (i.e. economic position of men and women) and reproduction (i.e. childbirth and parenting) constitute the opportunity structure for women’s cultural participation, because these structural inequalities reflect gender norms concerning women’s proper role in the family and the labor market. Yet, the impact of these macro-level inequalities on the gender gap in cultural consumption has received little empirical attention. Using multilevel analyses of recent Eurobarometer data, we study how structural gender stratification in terms of (re)production (i.a. women’s labor market participation and educational attainment) relates to gender differences in highbrow cultural consumption in the 28 EU countries anno 2013. Preliminary results indicate that the gender gap in highbrow cultural participation varies between EU countries and that this is partly explained by structural gender inequalities in terms of (re)production. Thus, our contribution highlights the importance of context to understand gender differences—and their implications—in cultural participation