Universal and Equal Access to Health-care

Services

Štefan Krajčík

Slovak Medical University

Bratislava, Slovakia

Universal and Equal Access to Health-care Services

Member States of the World Health Organization (WHO) committed in 2005 to develop their health financing systems so that all people have access to services and do not suffer financial hardship paying for them

Human Development Report 2005

http://hdr.undp.org/en/media/hdr05_summary.pdf

Questions on universal access to healthcare…

Who will this access be for ?

What should be its extent ?

Who will pay for it ?

The systems of healthcare payment

Payment in cash

Payment from taxes

Payment by insurance

Co-payment

What is necessary for universal access?

The key for universal access is

the solidarity of people with

higher incomes with people on

lower incomes and the solidarity

of healthy people with ill people

But how does it work ?

People needing solidarity

Children

Unemployed people

People with low incomes

Retired people

Disability

There are 80 million Europeans with disabilities. This is over 15% of the whole population. One in four Europeans has a family member with a disability.

http://www.edffeph.org/PageGenerale.asp?DocID=1254acceseed April 28. 2012

Unemployment rate in EU (%)

10,2

6,87,9

14,0

10,0

21,0

11,0

5,7

14,7

8,710,2

15,0

7,18,3

7,2

12,4

9,3 9,7

11,7

7,5

14,6 14,3

5,26,8

0,0

5,0

10,0

15,0

20,0

25,0

Euro

pea

n union

Cze

ch R

epub

lic

Denmark

Slovak

ia

France

Greece

Hungar

y

German

y

Irelan

d

Sloven

ia

Poland

Portugal

Roman

ia

United Kingdom

Belgium

Bulgaria

Italy

Cypru

s

Estonia

Finland

Latvia

Lithuan

ia

Luxe

mbourg

Malta

Low income

The minimum monthly wage in

Slovakia is 327 Euro. The high

unemployment rate increases

the number of people willing to

work for minimal wages.

Poverty rate In 2008, 17% of the population in the EU27

were at risk of poverty.

The highest at-risk-of-poverty rates in 2008 were found in Latvia (26%), Romania (23%), Bulgaria (21%), Greece, Spain and Lithuania (all 20%), and the lowest in the Czech Republic (9%), the Netherlands and Slovakia (both 11%), Denmark, Hungary, Austria, Slovenia and Sweden (all 12% )

http://epp.eurostat.ec.europa.eu/cache/ITY_PUBLIC/3-18012010-AP/EN/3-18012010-AP-EN.PDF

Population ageing in the world

1950 2050

% of people 60+

Potential support

ratio (PSR)

8

12

21

4

http://www.un.org/es/population/publications/wo

rldageing19502050/pdf/62executivesumma

Health care consumption in old age in the USA in 2010 26 percent of physician office visits

35 percent of hospital stays

34 percent of prescriptions

38 percent of emergency medical responses

90 percent of nursing home use

http://medical-careers-review.toptenreviews.com/the-rising-health-care-needs-of-aging-baby-boomers.html

Increase of healthcare costs

Average healthcare spending in

the EU27 will increase from 6.7%

of GDP in 2007 to 7.4% in 2030

and then to 8.4% in 2060. Przywara, B (2010), Projecting future health care expenditure

at European level: drivers, methodology and main results,

Brussels: European Commission.

Solidarity Insurance for 53% of population in

Slovakia is paid for from the national budget

Contributions from the state are only 4% of the average wage (i.e. 31,44 Euro per month)

Contributions of economically active people are 14% of their income (110 Euro for average wage)

The inbalance of income and expenditure in Slovakia The difference between income and

expenditure is about 15 % of income

It increases comparative to the size of hospital.

A lack of resources erodes the innovation of technology and maintenance of buildings. This concealed debt is estimated to be 1-3 Bn. Euro.

Double solidarity

The economically active people

‘show solidarity’ twice at present.

They pay both insurance and taxes.

If the principle of justice should be

preserved it is necessary to secure

health care for current payers when

they are in need of support.

Financial stress in healthcare More than 40% of specialists worry that

there is not enough healthcare funding in their country to meet future demands. One-third say there is less funding available for all healthcare provision. The same respondents see ageing as one of the biggest challenges facing healthcare systems.

A new vision for old age. Rethinking health policy for Europe’s ageing society. A report from the Economist Intelligence Unit http://www.bgs.org.uk/pdf_cms/pubs/economist_report_on_ageing.pdf

Solving the discrepancy between costs and income

Lower costs

Copayment of the care

Other solutions

Lowering cost Lower costs increase access to a

bigger number of people

Lowering cost of care may be

associated with a lower standard of

care

Efforts to decrease cost can result in

denying more expensive care to

some groups of patients.

Is it right ? The extent of fully-paid health care in

old age will be narrower and symptomatic treatment will be preferred to causal. The principle of justice will be preserved because everybody was young and had a claim to fully paid health care, which helped him/her to survive to old age.

Report on preparedness of health care resort to fulfill concept of health care- record from the 72th meeting of government, 25thFebr.2004

www.rokovania.sk

Myths and truths in using hi-technology with old people Using hi-tech equipment to treat wastes resources

and utilities of care in people nearing the end of

their natural life.

Most of the resources spent caring for older people

were spent on nonivasive treatments like medicine,

aids. etc. (Oberlander, 2005)

Hi-tech equipment, e.g. renal replacement therapy,

liver or heart transplantation done in selected older

people are cost-effective modes of treatment (Evans

1991)

Age itself is no contraindication

Equity in healthcare

Equity means that everybody

has the right that the provided

care will meet their needs as

much as possible.

Meeting healthcare needs of older people

Know how

Services

Attitudes

Know how „People aged 65 and over account for

70% of bed days in English general

hospitals, but traditional training of

doctors and nurses is still geared up

to a world where it’s all about young

people.” Professor David Oliver, in A new vision for old age .Rethinking health

policy for Europe’s ageing society. A report from the Economist

Intelligence Unit

http://www.bgs.org.uk/pdf_cms/pubs/economist_report_on_ageing.pdf

Services of older people

The nature of conditions affecting

older people requires concomitant

provision both social and health care

and building integrated system of

long term care

Some older people have special

needs

Special needs frequent in old age

Dementia (number of people with

dementia will increase in various

countries by 100 to 300%)

Falls and mobility problems

Attitudes

There is a strong discrepancy

between needs and deeds.

The driving force for the

restructuralisation of health care

provision reform is saving money

without the aim of better meeting

the needs of seniors.

Attitudes

42% of the respondents believe that

negative attitudes towards older

people constitute the leading barrier

to the provision of better care.

Rethinking health policy for Europe’s ageing society. A report from the

Economist Intelligence Unit

http://www.bgs.org.uk/pdf_cms/pubs/economist_report_on_ageing.pdf

Conclusion 1

There is no doubt that some issues in health care for seniors have improved but many others give me concern as a future recipient of care and fill me with disappointment as a professional engaged in this field for 31 years.

Conclusion 80% of all health professionals surveyed

are concerned about how they will be

treated when they are older.

A new vision for old ageRethinking health policy for Europe’s ageing

society

A report from the Economist Intelligence Unit

Thank you very much for your attention

This will have an impact on efforts to make

healthcare systems fit for the challenges

ahead. In our survey, 49% of respondents

say that ageing is regarded as a threat to the

viability of their countries’ national

healthcare systems,

but 50% say it provides the opportunity for

broader healthcare reforms, which are

needed anyway