Inequalities in utilization of institutional care among older people in Estonia

The purpose of this study is to shed light on various sources of inequalities in the utilization of institutional care among the Estonian elderly. We apply two-part hurdle and zero-inflated negative binomial models to analyze the association between various socioeconomic determinants and other factors on the one hand and the use of inpatient care and rehabilitation care services on the other. We discriminate between the two types of models using the new approach to comparing nonnested models – the HPC test. Applying the Lewbel estimator, we also explore the association between the utilization of inpatient care and rehabilitation. The evidence supports the existence of a pro-rich and pro-educated gradient in the needs-adjusted utilization of inpatient and rehabilitation care services among older people in Estonia. At the same time, we find no tangible urban/rural or ethnic barriers to the use of these services. The obtained results suggest the necessity of facilitating the accessibility of rehabilitation care services by mitigating both demand-side and supply-side barriers.