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      Economic crisis, austerity and unmet healthcare needs: the case of Greece

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          Abstract

          Background

          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.

          Methods

          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.

          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.

          Conclusions

          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.

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          Most cited references39

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          Health effects of financial crisis: omens of a Greek tragedy.

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            Greece's health crisis: from austerity to denialism.

            Greece's economic crisis has deepened since it was bailed out by the international community in 2010. The country underwent the sixth consecutive year of economic contraction in 2013, with its economy shrinking by 20% between 2008 and 2012, and anaemic or no growth projected for 2014. Unemployment has more than tripled, from 7·7% in 2008 to 24·3% in 2012, and long-term unemployment reached 14·4%. We review the background to the crisis, assess how austerity measures have affected the health of the Greek population and their access to public health services, and examine the political response to the mounting evidence of a Greek public health tragedy. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              Subjective unmet need and utilization of health care services in Canada: what are the equity implications?

              This study aimed to evaluate whether subjective assessments of unmet need may complement conventional methods of measuring socioeconomic inequity in health care utilization. This study draws on the 2003 Canadian Community Health Survey to develop a conceptual framework for understanding how unmet need arises, to empirically assess the association between utilization and the different types of unmet need (due to waiting times, barriers and personal reasons), and to investigate the effect of adjusting for unmet need on estimates of income-related inequity. The study's findings suggest that a disaggregated approach to analyzing unmet need is required, since the three different subgroups of unmet need that we identify in Canada have different associations with utilization, along with different equity implications. People who report unmet need due to waiting times use more health services than would be expected based on their observable characteristics. However, there is no consistent pattern of utilization among people who report unmet need due to access barriers, or for reasons related to personal choice. Estimates of inequity remain unchanged when we incorporate information on unmet need in the analysis. Subjective assessments of unmet need, namely those that relate to barriers to access, provide additional policy-relevant information that can be used to complement conventional methods of measuring inequity, to better understand inequity, and to guide policy action. Copyright 2009 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                dzavras@gmail.com
                zavras@bu.edu
                +302132010242 , i.kyriopoulos@lse.ac.uk , ilias.kyriopoulos@gmail.com
                jkyriopoulos@esdy.edu.gr
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                27 July 2016
                27 July 2016
                2016
                : 16
                : 309
                Affiliations
                [1 ]Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, 11521 Athens, Greece
                [2 ]Department of Pediatric Dentistry, Goldman School of Dental Medicine, Boston University, 100 E Newton Street, Suite 706, Boston, MA 02118 USA
                [3 ]Department of Social Policy, London School of Economics and Political Science, London, UK
                Article
                1557
                10.1186/s12913-016-1557-5
                4962475
                27460938
                b7977203-e61f-43cd-a19d-5759e3847cfc
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 June 2016
                : 14 July 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Health & Social care
                austerity,economic crisis,healthcare,unmet healthcare needs,demand,utilization,greece
                Health & Social care
                austerity, economic crisis, healthcare, unmet healthcare needs, demand, utilization, greece

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