Contextual Moderations of Age and Status Inequalities in Access to Healthcare

The article analyzes the problem of social inequalities in access to healthcare services in different countries of the world, including Russia. In modern research, such a subjective indicator as unmet medical care needs has become widely used in order to measure these inequalities. In particular, it was found that with age this indicator decreases significantly, while in economically vulnerable groups the values increase. Such age and status inequalities manifest to various degrees of intensity in different countries. However the rare attempts to explain such differences between countries using contextual variables have yet not been successful. In order to clarify the situation, this study conducts two-level logistic hierarchical modeling using survey data collected in 26 countries of the world under the International Social Survey Program (ISSP 2021) and statistics characterizing these countries. The results confirm that in some countries there are clear age and status inequalities when it comes to unmet needs for healthcare services, while in others they are more ambiguous, and such differences in how inequalities manifest can be explained by contextual factors that differentiate countries in terms of economic and welfare state development, accessibility and quality of healthcare systems. In developed countries inequalities are more pronounced than in underdeveloped countries. In the former, attention to socially vulnerable groups is a likely reason for the significant improvement in access to healthcare for older age cohorts and the persistence of access restrictions at younger ages. At the same time when analyzing status inequalities it becomes clear that they are more pronounced in developed countries. This confirms the assumption about the greater gain in access to medical services for individuals with high social status in countries with more complete coverage of the population with high-quality medical services. Such differences in inequality are explained by contextual factors — the development of the economy and the welfare state, the availability and quality of healthcare systems. In developed countries, inequalities turned out to be more noticeable than in underdeveloped countries. As such, significant age differences reflect the advantages of older people in access to medical care compared to young people. Clear status inequalities in these countries indicate that with low social status a person has to deal with barriers when it comes to healthcare provision much more often than if they had been a person of higher status. In our country, restrictions in access to healthcare services turned out, according to the data we acquired, to be among the highest in the world.