Universal and Equal Access to Health-care Services. Štefan Krajčík Slovak Medical University Bratislava, Slovakia

Transcription

1 Universal and Equal Access to Health-care Services Štefan Krajčík Slovak Medical University Bratislava, Slovakia

2 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

3 Questions on universal access to healthcare Who will this access be for? What should be its extent? Who will pay for it?

4 The systems of healthcare payment Payment in cash Payment from taxes Payment by insurance Co-payment

5 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?

6 People needing solidarity Children Unemployed people People with low incomes Retired people

7 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. ID=1254acceseed April

8 Unemployment rate in EU (%) 25,0 20,0 21,0 15,0 10,0 5,0 10,2 6,8 7,9 14,0 10,0 11,0 5,7 14,7 8,7 10,2 15,0 7,1 8,3 7,2 12,4 9,3 9,7 11,7 7,5 14,6 14,3 5,2 6,8 0,0 European union Czech Republic Denmark Slovakia France Greece Hungary Germany Ireland Slovenia Poland Portugal Romania United Kingdom Belgium Bulgaria Italy Cyprus Estonia Finland Latvia Lithuania Luxembourg Malta

9 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.

10 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% )

11 Population ageing in the world % of people Potential support ratio (PSR) 12 rldageing /pdf/62executivesumma 4

12 Health care consumption in old age in the USA in 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

13 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 Przywara, B (2010), Projecting future health care expenditure at European level: drivers, methodology and main results, Brussels: European Commission.

14 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)

15 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.

16 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.

17 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 n_ageing.pdf

18 Solving the discrepancy between costs and income Lower costs Copayment of the care Other solutions

19 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.

20 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

21 Myths and truths in using hitechnology 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

22 Equity in healthcare Equity means that everybody has the right that the provided care will meet their needs as much as possible.

23 Meeting healthcare needs of older people Know how Services Attitudes

24 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

25 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

26 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

27 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.

28 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

29 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.

30 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

31 Thank you very much for your attention

32 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