Inequalities Between Migrants and Non-Migrants in Accessing and Using Health Services in Greece During an Era of Economic Hardship

Unmet healthcare needs in Southeastern Europe: a systematic review

Objectives

This study sought to systematically review the existing literature on self-reported unmet healthcare needs in Southeastern Europe.

Methods

A systematic literature review of quantitative evidence in English and Bulgarian was performed in July 2023 using the following databases: Medline, Embase and EconLit. Publications were only included if they used self-reported unmet healthcare needs as an indicator of access to healthcare, concerned people living in Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, Serbia, North Macedonia or Romania and if they were published after 2003. Quality assessment of the included publications was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool.

Results

Twenty-three publications of varying quality were included in the review. Significantly more evidence was available for Greece, Bulgaria and Romania than for the rest of the region. Data collected through Pan-European surveys were commonly used, but almost half of the studies were only descriptive. Generally, the prevalence of unmet healthcare needs has decreased over the years. Unmet healthcare needs were higher among people of lower socioeconomic and educational status, ethnic minorities and migrants and high cost was consistently identified as the primary barrier to accessing healthcare.

Conclusion

Unmet healthcare needs are more prevalent among already disadvantaged societal groups. A trend of a declining prevalence of unmet needs has been observed, but it is more notable in the more socioeconomically developed countries. Improving financial protection should be a priority for the healthcare systems.

Nexus of regional integration, socioeconomic determinants and sustainable development in belt and road initiative countries

This study evaluates the nexus of regional integration, socioeconomic determinants and sustainable development (SD) by investigating the effect of health, humans and age structure on sustainable development, with the regional integration (RI) as the moderating variable. Socioeconomic determinants have an important role in sustainable development, while regional integration has fueled up the development process. The sample is based on 64 Belt and Road (BRI) countries from 2003-2018. Pair-wise correlation results indicate that human development, health expenditure and age structure showed a positive relationship with sustainable development. Two-step System-GMM direct effect outcomes are mixed and reveal that human development, health expenditure per capita, age structure, governance index and population size have a positive impact on sustainable development. On the other hand, e-government, government size, and globalization showed negative effects on SD. Apart from that, the moderating channel of regional integration (RI), interaction term with human development and health expenditure, showed a significant and positive impact on sustainable development. However, age structure interaction with regional integration showed a negative impact on SD. Other socio-economic factors, i.e., governance index and population contribute positively towards SD. It can be concluded that the dynamic nature of sustainable development is positive and the net present value is increasing. Therefore, BRI countries are on the sustainable path from 2003-2018, as suggested by economic and social welfare theory. The integration of BRI can be labeled as an entrance to successful sustainable development. However, weak e-government systems, globalization and government resources need to be utilized amicably in Belt and Road countries. Driscoll-Kraay standard-errors regression confirmed and validated the two-step System-GMM results. The findings of the current research have important policy implications for balanced and sustainable growth.

The effectiveness of primary health care reforms in Greece towards achieving universal health coverage: a scoping review

INTRODUCTION

Between 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector. We conducted a scoping review to examine whether the Primary Health Care reforms during that period assisted the country in moving towards Universal Health Coverage.

METHODS

We performed a review of the literature on the following databases: Scopus, PubMed, Epistemonikos, Web of Science, and Google Scholar, including published research articles and grey literature. Findings were synthesised thematically, using the World Health Organization Universal Health Coverage dimensions: population coverage, service coverage, and financial protection.

RESULTS

Forty-four documents were included in this review. Out of these, thirty-eight were research-based (thirty-three qualitative, two quantitative, and three mixed design studies), two grey literature, and four legislative bills. The evidence suggests that despite the systemic interventions addressing longstanding distortions, population coverage, service coverage and financial protection have not significantly improved.

CONCLUSIONS

This review suggests that Primary Health Care reforms in Greece have not managed to substantially improve Universal Health Coverage, although some positive steps towards that direction have taken place with the establishment of community-based multidisciplinary health teams. Before further interventions are implemented, an evidence-based monitoring and evaluation mechanism is necessary in order to clearly evaluate their effectiveness and progress.

Severe Pharyngodynia Followed by Migratory Polyarthritis and High Fever in Young Immigrants: Remember That Rheumatic Fever Is Still Relevant in 2020!

Acute rheumatic fever (ARF) is the immune-mediated sequelae of untreated group-A streptococcal infection. In this regard, rheumatic heart disease is the most prominent manifestation with devastating long-term complications. In the postantibiotic era, ARF is extremely rare in high-income countries; thus, its diagnosis might escape the clinicians' notice. However, its incidence remains high not only in certain low- and middle-income regions with poor public health systems but also in socioeconomically vulnerable populations residing in high-income countries. Herein, we report two cases of ARF in young immigrant adults in order to highlight the need for increased clinical suspicion to establish a prompt and timely diagnosis of ARF and describe in detail its differential diagnosis and approach to treatment.

Factors that influence the health status of immigrants living in Greece

Aim

To examine the health status of immigrants living in Greece and investigate the factors that influence it.

Methodology

A cross-sectional study with 1152 immigrants (response rate = 60%) was conducted during April 2013 to March 2014. Regarding the sampling method, as there is no accurate census of immigrants in Greece the snowball sampling was used. Data collection included demographic characteristics, health status, medication and self-reported preventive health examinations of immigrants (blood count, blood pressure, cholesterol, and blood sugar measurement).

Results

The majority of immigrants originated from Albania (51.4%), while 52.6% were males with mean age 37.6 years. Of those 63.5% were working, 80.9% had legal documents for living and working in Greece and 58.2% had valid health and social security. Most of the immigrants (66.6%) considered their health as good/very good. Immigrants without health insurance, lower monthly family income and worst self-reported health did not adhere with their medication treatment due to cost. Immigrants with legal documents and health insurance performed more often blood count measurement, blood pressure measurement, cholesterol measurement and blood sugar measurement. Increased monthly family income was also associated with higher probability of blood count measurement. Very poor/poor/average self-reported health and increased age were associated with higher probability of taking medicines for chronic diseases.

Conclusions

Self-reported health of immigrants in Greece is good/very good while absence of health insurance and legal documents, lower income and worst self-reported health are associated with worst health outcomes.