Inequalities in cost-related forgone care among older adults: a repeated cross-sectional study

Background

Ensuring equitable healthcare provision is key in ageing societies, yet it may be hindered by financial barriers. We assessed changes and socioeconomic disparities in cost-related forgone medical and dental care among adults aged 65 years and older between 2017 and 2024 in nine OECD countries.

Methods

We used data from the 2017 and 2024 waves of the ‘International Health Policy Survey’, a population-based study of randomly sampled adults aged 65 or older (n = 11089 and 10153, respectively) from nine OECD countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Switzerland, UK, USA). Participants reported whether, in the last 12 months, financial constraints had led them to forgo medical (medical prescriptions, consultations, medical tests, treatments or follow-up consultations) or dental care, from which weighted rates of forgone care were computed. Disparities by income were assessed using stratified analyses and the weighted mean difference from mean.

Results

In 2024, cost-related forgone care ranged from 7% to 30% (4% to 24% for medical care, 4% to 24% for dental care). It was highest in the United States (30%) and Canada (27%), and lowest in the Netherlands (7%), Germany (10%), France, and the United Kingdom (both 12%). Overall, while rates of forgone care did not change between 2017 and 2024, income-based disparities tended to increase since 2017. In 2024, income-based disparities were the largest in the United States, Canada, New Zealand, and Switzerland. These disparities were more pronounced for dental care than for medical care.

Conclusions

Despite well-resourced healthcare systems and universal health coverage in most of these high-income OECD countries, cost-related forgone care remains frequent among older adults, and there was a trend toward increasing income disparities in forgone care. Healthcare policies should account for these growing disparities.

Key messages

• Cost-related forgone healthcare is frequent among older adults in high-income OECD countries, despite universal health coverage in most countries.

• Although overall rates of forgone care remained stable between 2017 and 2024, income-related disparities increased.