European Journal of Ageing

, Volume 6, Issue 3, pp 167–176 | Cite as

Forgone health care due to cost among older adults in European countries and in Israel

  • Howard LitwinEmail author
  • Eliyahu V. Sapir
Original Investigation


This study sought to identify the principal factors that predict forgone health care due to cost among European and Israeli older adults. The analysis applied the Andersen–Newman model of health service utilization to data from the first wave of the Survey of Health, Ageing and Retirement in Europe (n = 28,849). Relinquished health care was regressed on the predisposing characteristics, need factors and economic access attributes of the respondents, in general, and in each of 12 countries, in particular. The results showed that forgone health care due to cost occurs among a substantial minority of older adults. Moreover, relinquished care is associated with younger old age, greater health needs and perceived economic inadequacy. Although statistically significant in certain cases, country of residence does not constitute a robust predictor of health care relinquishment. Social policy should address the antecedents of forgone health care in order to more effectively meet the health needs of the older population.


SHARE Underutilization Health services Economic access Perceived income adequacy Out-of-pocket expenses 



The SHARE data collection was primarily funded by the European Commission through the Fifth Framework Program (project QLK6-CT-2001-00360 in the thematic program Quality of Life). Additional funding came from the US National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, Y1-AG-4553-01, and OGHA 04-064). SHARE data collection in Israel was funded by the US National Institute on Aging (R21 AG025169), by the German-Israeli Foundation for Scientific Research and Development, and by the National Insurance Institute of Israel. The Israel Gerontological Data Center was established by a grant from the Ministry of Science, and is supported by the Ministry of Senior Citizens.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Israel Gerontological Data CenterHebrew UniversityJerusalemIsrael

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