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Doetsch JN, Schlösser C, Barros H, Shaw D, Krafft T, Pilot E. A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable. Int J Equity Health 2023; 22:3. [PMID: 36604705 PMCID: PMC9815671 DOI: 10.1186/s12939-022-01806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. OBJECTIVE This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013). METHODS This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included. RESULTS The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status. CONCLUSION Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.
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Affiliation(s)
- Julia Nadine Doetsch
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Clara Schlösser
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Henrique Barros
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5808.50000 0001 1503 7226Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - David Shaw
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands ,grid.6612.30000 0004 1937 0642Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Thomas Krafft
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Eva Pilot
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Fleming P, Caffrey L, Belle SV, Barry S, Burke S, Conway J, Siersbaek R, Mockler D, Thomas S. How International Health System Austerity Responses to the 2008 Financial Crisis Impacted Health System and Workforce Resilience - A Realist Review. Int J Health Policy Manag 2022; 12:7420. [PMID: 37579453 PMCID: PMC10125082 DOI: 10.34172/ijhpm.2022.7420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. METHODS A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience. RESULTS Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks. CONCLUSION This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.
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Affiliation(s)
- Padraic Fleming
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | | | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Jacki Conway
- Everlake, 5 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - David Mockler
- Library Reader Services, Trinity College Dublin, The University of Dublin, St James Hospital, Dublin 8, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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3
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Petrovic D, Marcus K, Sandoval J, Cullati S, Piumatti G, Bodenmann P, Jackson YL, Durosier Izart C, Wolff H, Guessous I, Stringhini S. Health-related biological and non-biological consequences of forgoing healthcare for economic reasons. Prev Med Rep 2021; 24:101602. [PMID: 34976659 PMCID: PMC8683898 DOI: 10.1016/j.pmedr.2021.101602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 12/14/2022] Open
Abstract
Forgoing healthcare for economic reasons has been previously associated with adverse health outcomes, including a higher risk of hospitalization, a lower quality of life, and worse self-reported health. However, the exact cause-to-effect relation between forgoing healthcare and health-related outcomes has been insufficiently described. Here, we investigate the prospective health consequences of forgoing healthcare for economic reasons using data from “ReBus” (N = 400), a prospective study examining the health consequences of forgoing healthcare (Baseline: 2008–2013, Follow-up: 2014–2016). Using regression models, we explored the baseline determinants of forgoing healthcare, including socioeconomic, demographic, and pre-existing health-risk factors, and examined the associations between forgoing healthcare at baseline and health deterioration at follow-up, using highly pertinent biomarkers (glucose, glycated hemoglobin, lipids, blood pressure) and SF-36 questionnaire data. Low income, low occupation, low education, and smoking were associated with higher odds of forgoing healthcare at baseline. Forgoing healthcare for economic reasons at baseline was subsequently related to detrimental changes in glucose, high-density lipoprotein cholesterol (HDL), and blood pressure (BP) at follow-up, independently of baseline socioeconomic factors (Glucose-β = 0.19, 95%CI[0.03;0.34], HDL-β = -0.07, 95%CI[-0.14;0.01], BP-β = 3.30, 95%CI[-0.01;6.60]). Moreover, we found strong associations between forgoing healthcare and adverse SF-36 health scores at follow-up, with individuals forgoing healthcare systematically displaying worse health scores (6%–11% lower scores). For the first time, we show that forgoing healthcare for economic reasons predicts adverse health-related consequences 2–8 years later. Our findings shall further encourage the implementation of public health measures aimed at identifying individuals who forgo healthcare and preventing the adverse health consequences of unmet medical needs.
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Affiliation(s)
- Dusan Petrovic
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland.,Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Kailing Marcus
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - José Sandoval
- Department of Oncology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, Switzerland.,Quality of Care Service, Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Switzerland
| | | | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland.,Faculty of Biology and Medicine, Deanship, University of Lausanne, Lausanne, Switzerland
| | - Yves-Laurent Jackson
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Claire Durosier Izart
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Hans Wolff
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Idris Guessous
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Silvia Stringhini
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland
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4
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The 2008 Financial Crisis and Changes in Lifestyle-Related Behaviors in Italy, Greece, Spain, and Portugal: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168734. [PMID: 34444482 PMCID: PMC8392284 DOI: 10.3390/ijerph18168734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022]
Abstract
Italy, Greece, Spain, and Portugal have all been strongly affected by the 2008 financial crisis, which has had a negative impact on health. We systematically evaluated the effects of the crisis on lifestyle and socioeconomic inequalities. We conducted a literature search using MEDLINE, Embase, the Cochrane Library, and health economics databases for studies reporting quantitative comparisons before and after (or during) the crisis on the following risk behaviors: alcohol consumption, smoking habit, healthy diet, physical activity, and psychotropic drugs and substance abuse, without setting any age restrictions. We selected 34 original articles published between 2011 and 2020. During/after the crisis, alcohol consumption and substance abuse decreased, while psychotropic drug use increased. We also observed a deterioration in healthy eating behavior, with a reduction in fruit and vegetable consumption. Smoking habit and physical activity showed a more complex, controversial trend. Socioeconomic inequalities were affected by the recession, and the negative effects on unhealthy lifestyle tended to be more pronounced among the disadvantaged. These results suggest the need to implement health policies and interventions aimed at monitoring risk behaviors, with special regard to disadvantaged people, and considering the potential additional impact of the COVID-19 pandemic.
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5
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Corrao G, Rea F, Carle F, Di Martino M, De Palma R, Francesconi P, Lepore V, Merlino L, Scondotto S, Garau D, Spazzafumo L, Montagano G, Clagnan E, Martini N, Bucci A, Carle F, Dajko M, Arcà S, Bellentani D, Bruno V, Carbone S, Ceccolini C, De Feo A, Lispi L, Mariniello R, Masullo M, Medici F, Pisanti P, Visca M, Zanini R, Di Fiandra T, Magliocchetti N, Romano G, Cantarutti A, Corrao G, Pugni P, Rea F, Davoli M, Fusco D, Di Martino M, Lallo A, Marinacci C, Maggioni A, Vittori P, Belotti L, De Palma R, Di Felice E, Chiandetti R, Clagnan E, Del Zotto S, Di Lenarda A, Mariotto A, Zanier L, Agnello M, Lora A, Merlino L, Scirè CA, Sechi G, Spazzafumo L, Massaro G, Simiele M, Cosentino M, Marvulli MG, Attolini E, Bisceglia L, Lepore V, Petrarolo V, Dondi L, Martini N, Pedrini A, Piccinni C, Fantaci G, Addario SP, Scondotto S, Bellomo F, Braga M, Di Fabrizio V, Forni S, Francesconi P, Profili F, Avossa F, Corradin M, Bucci A, Carle F, Dajko M, Arcà S, Bellentani D, Bruno V, Carbone S, Ceccolini C, De Feo A, Lispi L, Mariniello R, Masullo M, Medici F, Pisanti P, Visca M, Zanini R, Di Fiandra T, Magliocchetti N, Romano G, Cantarutti A, Corrao G, Pugni P, Rea F, Davoli M, Fusco D, Di Martino M, Lallo A, Marinacci C, Maggioni A, Vittori P, Belotti L, De Palma R, Di Felice E, Chiandetti R, Clagnan E, Del Zotto S, Di Lenarda A, Mariotto A, Zanier L, Agnello M, Lora A, Merlino L, Scirè CA, Sechi G, Spazzafumo L, Massaro G, Simiele M, Cosentino M, Marvulli MG, Attolini E, Bisceglia L, Lepore V, Petrarolo V, Dondi L, Martini N, Pedrini A, Piccinni C, Fantaci G, Addario SP, Scondotto S, Bellomo F, Braga M, Di Fabrizio V, Forni S, Francesconi P, Profili F, Avossa F, Corradin M. Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study. Eur J Public Health 2020; 30:916-921. [DOI: 10.1093/eurpub/ckaa063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy.
Methods
Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared.
Results
Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones.
Conclusion
MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.
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Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Flavia Carle
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rossana De Palma
- Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Paolo Francesconi
- Regional Health Agency of Tuscany (Agenzia regionale di sanità), Florence, Italy
| | - Vito Lepore
- Regional Health Agency of Puglia (Agenzia regionale socio-sanitaria), Bari, Italy
| | - Luca Merlino
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | | | - Donatella Garau
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Regional Councillorship of Health ‘Regione Autonoma della Sardegna’, Cagliari, Italy
| | - Liana Spazzafumo
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Biostatistics Centre, INRCA-IRCCS National Institute, Ancona, Italy
| | | | - Elena Clagnan
- Regional Health Agency of Friuli-Venezia-Giulia (Azienda Regionale di Coordinamento per la Salute), Udine, Italy
| | - Nello Martini
- Research and Health Foundation (Fondazione ReS-Ricerca e Salute), Bologna, Italy
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