Access regulation and utilization of healthcare services

"Regulating patients' access to healthcare has been used in several countries as a way of controlling patients' consumption levels. In some countries, provider choice is directly limited through legal regulations such as gatekeeping, whereas in other countries patients' behavior is primarily governed by financial incentives like co-payments to doctor visits. However, empirical studies, mostly conducted in the United States, do not provide a clear answer whether institutional access regulations actually accomplish a reduction of used health services. The objective of this paper is to assess the impact of access regulations on healthcare utilization in a cross-national framework comparing eleven European countries. While access restrictions are assumed to have an effect on the overall level of utilization, they can also have an impact on the equity of utilization between different socio-economic groups. Our analyses combine institutional indicators on the country level and number of doctor visits on the micro-level from the first wave of SHARE. The results show that access regulations and especially gatekeeping systems are associated with a lower level of overall service usage. Gatekeeping systems also reduce inequity in specialist visits across groups with different levels of education. Contrary to theoretical expectations but in line with earlier studies cost sharing could not be related to inequity patterns across income groups." (author's abstract

Choice in maternity care and childcare policies in the Netherlands and Germany

This paper investigates whether choice has gained importance as a political narrative and factually in care policies in Germany and the Netherlands since the late 1980s. Previous literature suggests that welfare reform introduced an increasing focus on choice in various policy areas in Bismarckian welfare states and beyond, but whether choice is a central aspect across different care policies is not well understood. We argue that choice is an important component for analysing change in family-related policies, because it reflects how much welfare states have moved towards supporting individualism in family arrangements. Moreover, economic as well as sociological research is interested in choice due to its association with quality of care and inequalities. By analysing maternity care policies alongside childcare policies, we also add a hitherto often neglected state intervention in family life, i.e. policies addressing pregnancy and childbirth

Regional inequalities in self-reported conditions and non-communicable diseases in European countries: Findings from the European Social Survey (2014) special module on the social determinants of health

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, ‘NUTS’). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs

Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherland

Background: Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of changes in smoking behavior was also evaluated. Methods: To quantify the contribution of changes in HCE to changes in LE, we estimated a health-production function using a dynamic panel regression approach with data on 19 OECD countries (1980-2009), accounting for temporal and spatial correlation. Smoking-attributable mortality was estimated using the indirect Peto-Lopez method. Results: As compared to 1990-1999, during 2000-2009 LE in the Netherlands increased by 1.8 years in females and by 1.5 years in males. Whereas changes in the impact of smoking between the two periods made almost no contribution to the acceleration of the increase in LE, changes in the trend of HCE added 0.9 years to the LE increase between 2000 and 2009. The exceptional reversal in the trend of LE and HCE was not found among the other OECD countries. Conclusion: This study suggests that changes in Dutch HCE, and not in smoking, made an important contribution to the reversal of the trend in LE; these findings support the view that investments in healthcare are increasingly important for further progress in life expectancy

How healthcare systems matter : an international comparative analysis of access to healthcare and its implications

Soziale Probleme ; Sozialdienste ; Versicherunge

Parenthood and later life health: an international life course analysis of parents and childless adults aged 50 and over

This study investigates how women’s and men’s fertility history affect their health in later life and if this relationship varies across countries and cohorts. We use life history data and current health status of persons aged 50 and over from the Survey of Health, Ageing and Retirement in Europe (SHARE) for 13 countries. Country-fixed effects regressions show that parenthood itself and the number of children have little impact on later life health, but fertility timing is important. Moreover, significant country and cohort differences show that the health implications of timing depend upon the socio-historic context