Healthcare Facilities Satisfaction Among Older Adults by European Union Health System Clusters

Abstract Health systems in Europe differ due to political, historical, cultural, and socio-economic factors, affecting older adults’ satisfaction with healthcare facilities. Classifying EU health systems into clusters supports international comparisons and policy development. This study applies Andersen's Behavioral Model, which suggests that satisfaction and healthcare use are shaped by predisposing, enabling, and need factors. To examine how these factors relate to healthcare facilities satisfaction among older adults across EU health system clusters. We analyzed data from Wave 9 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), using a sample of older adults from 10 EU countries. Non-parametric ANOVA (Kruskal-Wallis) and Multinomial Logistic Regression tested two hypotheses: (1) satisfaction does not differ across health system clusters, and (2) predisposing, enabling, and need factors do not predict satisfaction. Healthcare satisfaction differed significantly across clusters (Chi-Square = 306.52, df = 21, p < 0.001). Age and gender (predisposing), technology access (enabling), and mental health and chronic disease (need) were significant predictors of satisfaction (Chi-Square = 42.47, df = 3, p < 0.001). Among those highly dissatisfied, key predictors included poor mental health (β = 1.84), chronic disease (β = 1.09), and younger age (β = -1.40), all p < 0.001. Technology access negatively predicted dissatisfaction (β = -0.161, p < 0.001). Satisfaction with healthcare facilities varies significantly by EU health system cluster. Mental health, chronic disease, age, and technology access are strong predictors. Interventions should target vulnerable subgroups, especially older adults with mental health conditions or chronic illness. Investment in digital infrastructure and literacy is also crucial to enhance satisfaction and healthcare accessibility for aging populations. Key messages • The classification of European Union (EU) health systems into clusters has facilitated international comparisons and informed policy recommendations. • Healthcare facilities satisfaction varies across EU health system clusters, with key predictors including mental health, chronic disease, age, and technology access.