Cross-National Differences in Wealth Inequality in Health Services and Caregiving Used Near the End of Life
Background: Socioeconomic inequality in access to and use of health services and social care provided near the end of life, or end-of-life care (EOLC), is not well understood in many countries. Wey examined wealth inequality in EOLC – hospital, nursing home, and hospice use and receipt of formal and informal caregiving – in the USA, South Korea, Mexico and 19 European countries.Methods: We used harmonized data from nationally representative studies of people aged 50 and older that collected information on healthcare utilisation and caregiving receipt in the time preceding death. We categorized countries according to their level of public long-term care (LTC) spending and examined EOLC prevalence across countries. We used logistic regression models to estimate wealth inequality in each type of EOLC. Findings: In the USA the least wealthy had more hospital (OR 1.30, p =0.008) and nursing home/care (OR 1.88,p <0.001) use. In South Korea the least wealthy had more nursing home/care use (OR 2.24, p =0.003). The least wealthy in high LTC Europe had less hospice use (OR 0.56, p =0.003). The least wealthy were also less likely to be hospitalized in European countries with low LTC spending (OR 0.81, p =0.04), but more likely to receive informal caregiving (OR 1.25, p =0.033). Formal care was more common among the least wealthy in high LTC Europe (OR 1.57, p =0.002), the USA (OR 1.42, p <0.001) and South Korea (OR 1.69, p =0.028), but less common among the least wealthy in Mexico (OR 0.17, p <0.001).Interpretation: Wealth inequality in EOLC exists across countries and reflects differences in the organization, financing, and delivery of care in different countries. The findings highlight the need to consider equity in current and future plans to improve EOLC access.Funding Information: This work was supported by the National Institute on Aging (R01AG030153). The views expressed are those of the authors and not necessarily those of the National Institute of Aging. The Harmonized HRS End of Life, Harmonized SHARE End of Life, Harmonized KLoSA End of Life, and Harmonized MHAS End of Life was developed by a the Gateway to Global Aging team, with funding from the National Institute on Aging (R01 AG030153).Declaration of Interests: We declare no competing interests
Year of publication: |
[2023]
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Authors: | Ailshire, Jennifer A. ; Herrera, Cristian A. ; Choi, Eunyoung ; Osuna, Margarita ; Suzuki, Elina M. |
Publisher: |
[S.l.] : SSRN |
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