2 krajcik-universal and equal access to health-care services
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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