Choice and vulnerability in aging societies: Understanding the impact of age on user capacity

One necessary condition for realizing the benefits of choice-based models of public service provision is that the service users in a given sector are capable of exercising choice. However, along with population aging, critics may question the level of user capacity in the growing user group consisting of older citizens with healthcare needs. For the first time in an older-aged sample (52 to 97 years, N ~ 10,000), this study examines the link between age and user capacity (public service efficacy). Our results from the hospital sector in Denmark reveal a negative age gradient, where those of advanced age and declining health report significantly lower public service efficacy. However, when examining this age gap, much is attributable to cohort differences in educational attainment. Thus, while current generations of older service users constitute a vulnerable group under choice-based policies, this challenge is likely to diminish in the future.