Two decades of change

: the role of socio-economic determinants in the access to health of the retired European population

Abstract

This study explores the impact of socio-economic inequalities on healthcare access, self-perception, and non-communicable diseases (NCD) evolution among the elderly in Europe over five different years, using data from Survey on health, ageing and retirement in Europe (SHARE) and applying a Hierarchical Ordered Probit (HOPIT) model. The analysis highlights how the Great Recession introduced disparities, with lasting effects on financial and health vulnerabilities, while the pandemic further exposed the fragility of health systems. Contrary to expectations, mental health has not worsened, but pessimism has increased its impact on health in the Great Recession and COVID-19. Socioeconomic factors, alongside education, were found to be crucial in shaping health perception. Although education is important for how individuals perceive their health, income and net-worth assume a critical function under conditions of socioeconomic vulnerability, by enabling access to healthcare services and influencing health outcomes. The study suggests that policies should focus on improving access to healthcare for low-income groups and addressing systemic health inequalities. Limitations include the exclusion of macroeconomic and genetic factors, and future research should examine the role of diverse health systems in reducing disparities across Europe.

Date of Award	4 Jul 2025
Original language	English
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Luís Pina-Rebelo (Supervisor)