Left behind: Long-term care gaps and healthcare access in later life

Abstract Population ageing, changing household structures, and the declining availability of informal family care are increasing unmet long-term care (LTC) needs across Europe. While previous studies have documented the health consequences of unmet LTC needs, much less is known about their implications for healthcare access. This paper examines the relationship between unmet LTC needs and healthcare access among older Europeans, conceptualising LTC as an enabling input that helps individuals with functional limitations overcome mobility and organisational barriers to healthcare utilisation. Using data from Waves 8 and 9 of the Survey of Health, Ageing and Retirement in Europe (SHARE), combined with both waves of the SHARE Corona Survey, I analyse individuals aged 65 and over with functional limitations. To address the potential endogeneity of unmet LTC needs, I implement an instrumental-variable strategy that exploits variation in the availability of informal care provided by adult children. The IV estimates suggest that unmet LTC needs are associated with substantially lower use of healthcare services, with larger effects for services requiring greater mobility and organisational support, such as hospital admissions and preventive care, than for GP contacts. These findings are consistent with LTC reducing non-monetary barriers to healthcare access and with shortcomings in LTC provision generating spillover effects on the healthcare system. More broadly, the results highlight the continuing role of family support in facilitating healthcare access among older adults, while underscoring the growing importance of formal LTC systems as demographic change and declining informal caregiving reduce households’ capacity to meet care needs. Strengthening LTC provision may therefore improve equity in healthcare access and contribute to more efficient healthcare delivery in ageing societies.