Voluntary health insurance in frailty onset and progression: evidence from SHARE
1
Department of Public Health, University of Naples "Federico II", Naples, Italy
Popul. Med. 2026;8(Supplement Supplement 1):A118
ABSTRACT
INTRODUCTION:
Frailty is a syndrome characterized by physiological decline and increased vulnerability to adverse health outcomes. In Europe, the prevalence of frailty and pre frailty is substantial and unequally distributed across socioeconomic groups. Concurrently reductions in public health spending have contributed to the growing diffusion of voluntary health insurance (VHI), which may improve access to care but also risk widening health inequalities. This study aimed to estimate the prevalence of VHI and evaluate its association with frailty progression and onset among European adults aged above 50 years.
METHODS:
Longitudinal data from waves 5 to 9 of the survey of health ageing and retirement in Europe collected between 2013-22 were analyzed. The study included 191848 individuals from 17 countries. Frailty was assessed using the SHARE Frailty Instrument and modelled both as a continuous score and as incident frailty. Mixed effects linear regression was used to examine frailty progression while cox proportional hazards models estimated the risk of frailty onset. Analyses were adjusted for sociodemographic socioeconomic and health related covariates and stratified by income quartiles and country of residence.
RESULTS:
Overall, 37% of participants reported VHI with substantial variation by country and income. VHI was associated with lower frailty scores (coeff. -0.056 95% CI -0.071 to -0.041), with the strongest association observed in the lowest income quartile. In survival analyses including 53873 participants and 311695 person years, VHI was associated with a reduced risk of frailty onset (HR 0.862 95% CI 0.763 to 0.973). This figure was particularly evident in the second income quartile and in Spain.
CONCLUSIONS:
VHI was associated with a lower risk of frailty progression and onset among older European adults. While these findings suggest a potential protective role of voluntary coverage, reliance on out-of-pocket insurance may also exacerbate health inequalities if not adequately integrated within universal health systems.
Frailty is a syndrome characterized by physiological decline and increased vulnerability to adverse health outcomes. In Europe, the prevalence of frailty and pre frailty is substantial and unequally distributed across socioeconomic groups. Concurrently reductions in public health spending have contributed to the growing diffusion of voluntary health insurance (VHI), which may improve access to care but also risk widening health inequalities. This study aimed to estimate the prevalence of VHI and evaluate its association with frailty progression and onset among European adults aged above 50 years.
METHODS:
Longitudinal data from waves 5 to 9 of the survey of health ageing and retirement in Europe collected between 2013-22 were analyzed. The study included 191848 individuals from 17 countries. Frailty was assessed using the SHARE Frailty Instrument and modelled both as a continuous score and as incident frailty. Mixed effects linear regression was used to examine frailty progression while cox proportional hazards models estimated the risk of frailty onset. Analyses were adjusted for sociodemographic socioeconomic and health related covariates and stratified by income quartiles and country of residence.
RESULTS:
Overall, 37% of participants reported VHI with substantial variation by country and income. VHI was associated with lower frailty scores (coeff. -0.056 95% CI -0.071 to -0.041), with the strongest association observed in the lowest income quartile. In survival analyses including 53873 participants and 311695 person years, VHI was associated with a reduced risk of frailty onset (HR 0.862 95% CI 0.763 to 0.973). This figure was particularly evident in the second income quartile and in Spain.
CONCLUSIONS:
VHI was associated with a lower risk of frailty progression and onset among older European adults. While these findings suggest a potential protective role of voluntary coverage, reliance on out-of-pocket insurance may also exacerbate health inequalities if not adequately integrated within universal health systems.
| eISSN: | 2654-1459 |
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