Health experts alert to diverse barriers for patients in accessing care during the European Public Health Week
The European Observatory on Health Systems and Policies kicked off the third day (24 May) of the European Public Health Week, an initiative by the European Public Health Association (EUPHA), under the theme ‘access to care’.
Access to care is essential for patients to obtain diagnostics, access treatments, but also for health promotion and prevention. However, very often this is not a given due to gaps in health coverage.
According to a 2022 European survey, almost one in five respondents has an unmet healthcare need – mostly for specialist care, dental care and mental care. With 42% of respondents in the age category 18 to 24 reporting an unmet need, among women, one in four reported mental health care needs.
However, the overall issue is that “the available indicators fail to delimit the underlying reasons for those access gaps,” said Ewout van Ginneken, coordinator of the Observatory’s Berlin hub in the keynote speech of the online EUPHW event.
“If we don't really know the underlying reasons, it's hard to develop concrete policies to target them,” he said, adding that “we have a long way in terms of data collection. That will be a prerequisite to have better, more targeted policies, and increase access for people in Europe.”
Access to care for vulnerable populations
This lack of information can, for example, prevent policy-makers from identifying vulnerable groups. According to Bernadette Kumar from the EUPHA Section on Migrant and Ethnic Minority Health, when it comes to coverage, a lot of data is incomplete and not available as routine data of migrant groups and ethnic minorities.
Kumar highlighted that migrant groups in particular face poor access to care and poor quality of care “because many of them fall out of the entitlements and rights that other citizens in countries and host populations have” - such as legal rights, job security or information accessibility.
“We have seen both with the temporary directive for Ukrainians, as well as with what happened in COVID, with countries like Portugal, for example, leading and allowing all migrant groups including undocumented migrants to access health care,” she added.
Dental care coverage is another example of unmet needs. Juliane Winkelmann, Technical Officer at the Observatory, explained that “even before the pandemic, it was one of the medical areas where out-of-pocket payments and unmet needs were the highest.”
However, there is a large diversity across Europe, from countries like Spain and Portugal where coverage is quite limited, to Czechia, Austria and Germany, where it is very comprehensive. France, for example, has led the “most comprehensive reform in the area of dental care,” according to Winkelmann, by trying to increase the coverage and reduce cost-sharing.
Organisational, financial, educational and geographical barriers in the patient’s journey
According to Jon Cylus, health economist leading the London hub of the Observatory, “all countries in Europe rely, to some extent, on out-of-pocket payments to pay for health care,” which can cause financial hardship for some households.
However, the risk of financial hardship does not only depend on the household’s ability to pay for health services, but to a larger extent it varies depending on the country and which coverage policies are put in place.
Waiting times - or organisational barriers - can also prevent patients from accessing care services. “The starting point has to be to increase the volume and the supply,” said Luigi Siciliani, from the University of York. However, that’s only one part of the solution.
At the moment, “this is more about the retention policies of current workers,” he said, adding that there have to be policies in place that improve the workforce’s working conditions.
Likewise, geographical barriers such as living in rural areas or having to rely on public transport play a role in accessing care.
Between 2020 and 2021, the share of adults in OECD countries that had medical consultations online or by phone increased to 45% on average, according to Anna Odone, from the EUPHA Section on Digital Health. “We need economic investments, and now we're using funds from Europe to support this transition to telehealth and teleconsultation within the National Health Service,” she concluded.
Finally, overcoming health literacy barriers - or having people use the information they have available - needs catching up with “new developments”, said Miguel Arriaga, who leads the Division of Literacy, Health and Well-being at Portugal’s health authority.
He highlighted the importance of working “with people and with people’s needs” to ensure patients access the information to navigate and make the correct choices.
Overall, experts pointed out that understanding better the root causes of the different barriers to access care is part of the solution, as well as working on prevention services and health promotion.
“We need to also make sure that people are co-designing from the beginning the solutions to those barriers,” said Rosa Castro from the European Public Health Alliance, adding that “civil society has a key role to play” in this task.