title: Economic crisis, austerity and unmet healthcare needs: the case of Greece.
abstract: The programme for fiscal consolidation in Greece has led to income decrease and several changes in health policy. In this context, this study aims to assess how economic crisis affected unmet healthcare needs in Greece.
  
  
  
  Time series analysis was performed for the years 2004 through 2011 using the EU-SILC database. The dependent variable was the percentage of people who had medical needs but did not use healthcare services. Median income, unemployment and time period were used as independent variables. We also compared self-reported unmet healthcare needs drawn from a national survey conducted in pre-crisis 2006 with a similar survey from 2011 (after the onset of the crisis). A common questionnaire was used in both years to assess unmet healthcare needs, including year of survey, gender, age, health status, chronic disease, educational level, income, employment, health insurance status, and prefecture. The outcome of interest was unmet healthcare needs due to financial reasons. Ordinary least squares, as well as logistic regression analysis were conducted to analyze the results.
  
  
  
  Unmet healthcare needs increased after the enactment of austerity measures, while the year of participation in the survey was significantly associated with unmet healthcare needs. Income, educational level, employment status, and having insurance, private or public, were also significant determinants of unmet healthcare needs due to financial reasons.
  
  
  
  The adverse economic environment has significantly affected unmet health needs. Therefore health policy actions and social policy measures are essential in order to mitigate the negative impact on access to healthcare services and health status.
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Zavras
authors.affiliation: Department of Pediatric Dentistry, Goldman School of Dental Medicine, Boston University, 100 E Newton Street, Suite 706, Boston, MA, 02118, USA.
authors.forename: Athanasios I
authors.initials: AI
authors.lastname: Zavras
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece. i.kyriopoulos@lse.ac.uk.|Department of Social Policy, London School of Economics and Political Science, London, UK. i.kyriopoulos@lse.ac.uk.
authors.forename: Ilias-Ioannis
authors.initials: II
authors.lastname: Kyriopoulos
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
mesh_terms: D002908:Chronic Disease / Q000191:economics* / Q000453:epidemiology; D057172:Economic Recession / Q000706:statistics & numerical data*; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006115:Greece / Q000453:epidemiology; D006291:Health Policy / Q000191:economics; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D010549:Personal Satisfaction; D057566:Self Report; D012923:Social Class; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000706:statistics & numerical data
keywords: Austerity; Demand; Economic crisis; Greece; Healthcare; Unmet healthcare needs; Utilization