ESN at Eurofound expert workshop
On 25 April the European Social Network (ESN) participated in an expert workshop on the access to healthcare services in times of crisis, organised by the European Foundation for the Improvement of Living and Working Conditions (Eurofound). The aim of the meeting was to discuss Eurofound’s draft research report ‘Access to healthcare in times of crisis’ with 35 participants from European, international and national organisations.
The report draws on country studies from Greece, Hungary, Ireland, Latvia, Luxembourg, Portugal, Romania, Slovenia and Sweden and aims to map how access to healthcare services has been affected by the crisis, especially for certain groups in vulnerable situations. Moreover, it presents mitigating measures that have been taken to maintain access.
The report identifies Roma, migrants, older people, people with chronic health conditions, those with disabilities and mental health problems, unemployed people, patients with specific health problems and people living in rural areas as groups who had limited access to healthcare.
Country case studies
A case study from Greece by Olga Siskou from Athens University showed decreased access to healthcare services due to reduced state funding and coverage by insurance. In order to provide healthcare to particular groups, the state has introduced healthcare vouchers and access to basic health services provided by NGOs in the country. A Swedish case study showed a trade-off between quality and access to services - a small emergency ward in a remote area was closed due to large debts and reopened in a care centre for the elderly.
After having discussed the impacts of the crisis, participants looked at examples by service providers or governments to maintain access to healthcare services. Some of the measures presented in the report were:
- Reducing informal payments or introducing exemptions to extend coverage of groups in vulnerable situations
- Reducing in-patient care
- Economising costs
- Economising and incentivising staff
- Seeking new funding
- Scaling-up services provision, keeping basic services accessible
- Prioritising medically urgent cases
A case study from Hungary showed how cuts in home care services for physically disabled people in Budapest were addressed by task-sharing with social care services, NGOs and through the introduction of service user charges. In another case study from Portugal, a hospital introduced a screening mechanism and training of staff to use new technologies. These examples showed gains in efficiency, but also how much they depended on the willingness of staff to do more. Another case study from Romania showed a remote hospital working to decrease in-patient care by increasing services providing primary and day care.
Impact and responses to the crisis
Eurofound’s report underlines that the impact of the crisis on healthcare services is complex and difficult to assess and that access to healthcare services is also affected by on-going reforms. It stresses that the economic crisis has greatly reduced disposable income and has led to the introduction of budget cuts to services, which have severely impacted the access to healthcare services, as well as access to social services.
Participants also discussed policy recommendations to address the impact of the crisis on healthcare services. They stressed the importance of investments in outpatient care and community care, investing in working conditions and staff training, as well as long-term thinking when implementing reforms, rather than setting up crisis focused emergency structures. Although the report only focuses on healthcare services, participants did bring up the role of prevention. Nicolas Peterson, the Chair of the Social Protection Committee (SPC) Working Group on Ageing, underlined the potential of prevention, rehabilitation and age-friendly environments to delay the need of older people of health and social care services.
Moreover, participants discussed the trade-off between quality and access to services as in some cases quality was reduced to maintain access. “We need to get financing and sustainability right. The way we want to go means reducing costs and maintaining high quality of care. Options for this are sustainable ways of funding health, rethinking of the benefit package or better value for money”, said Francesca Colombo from the OECD in her conclusion.
At the meeting, the European Social Network (ESN) stressed the role of local partnerships between health services and social services. This cooperation has an impact on access to health services for vulnerable people as it addresses the social dimension of health and influences efficiency and quality of care services. You can read more about this in our recent paper ‘‘Working with education, health and employment: recognising a shared agenda’’.
Eurofound’s final report on access to healthcare will be published in the autumn.