Unequal care, unequal health care? Gender differences in health care use after adult care access

Access to care among older adults can help identify unmet health needs and increase the use of health care, though in some cases it may substitute some forms of health care. We argue that the balance between these two effects is largely gender dependent: female spouses are more likely to act as informal caregivers and, as a result, are more likely to have neglected their own health needs. To examine this hypothesis, we exploit the variation introduced by Scotland's Free Personal Care (FPC) programme, a government initiative implemented in 2002 that provides free personal care access to all eligible individuals regardless of their income. Using a Difference-in-Differences (DiD) framework comparing Scotland with the rest of the United Kingdom and a rich longitudinal dataset of men and women aged 65 and over, we first find that FPC significantly increased the uptake of home help services among women, with little change among men. Among women, adult care expansion led to a 3.5-percentage-point rise in inpatient admissions, whereas among men, we find evidence suggesting a modest substitution effect of care for health care. The effects are stronger among older adults who live alone, and those facing socioeconomic disadvantage, or high care needs.