title: Health system characteristics and unmet care needs in Europe: an analysis based on EU-SILC data.
abstract: Using survey data from the 2009 wave of the European Union Statistics on Income and Living Conditions, this study examines the determinants of unmet needs for medical and dental care in European countries. Special emphasis is put on the impact of health system characteristics. Four factors are taken into account: the density of doctors or dentists, the rules governing access to practitioners, the method of paying primary care physicians, and the amount of out-of-pocket payments. The analysis is carried out using multilevel logistic regression models. Separate regressions are estimated for medical and dental services. The dependent variable is whether respondents reported that, at least once in the last 12 months, they needed care but did not receive it. The estimation results show that the probability of experiencing unmet medical or dental needs varies noticeably across countries. This inter-country variability seems to be partly explained by the differences in the financing of health care. Indeed, a positive link is found between the share of households' out-of-pocket payments in total health expenditure and the probability of unmet needs. The other contextual factors do not seem to play a significant role.
authors.affiliation: Bureau d'Economie Théorique et Appliquée, CNRS, University of Strasbourg, and University of Lorraine, 13, Place Carnot, C.O. n°70026, 54035, Nancy Cedex, France, Sabine.Chaupain@univ-lorraine.fr.
authors.forename: Sabine
authors.initials: S
authors.lastname: Chaupain-Guillot
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003813:Dentistry / Q000706:statistics & numerical data; D003815:Dentists / Q000331:legislation & jurisprudence; D004468:Economics, Dental; D005060:Europe; D005260:Female; D006078:Government Programs / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006306:Health Surveys; D006280:Health Workforce / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000331:legislation & jurisprudence; D058007:Physicians, Primary Care; D012959:Socioeconomic Factors; D055815:Young Adult