Legal and Regulatory Approaches to Rehabilitation Planning: A Concise Overview of Current Laws and Policies Addressing Access to Rehabilitation in Five European Countries

Abstract

Background: The rising prevalence of disability due to noncommunicable diseases and the aging process in tandem with under-prioritization and underdevelopment of rehabilitation services remains a significant concern for European public health. Over recent years, health system responses to population health needs, including rehabilitation needs, have been increasingly acknowledging the power of law and formal written policies as strategic governance tools to improve population health outcomes. However, the contents and scope of enacted legislation and adopted policies concerning rehabilitation services in Europe has not been synthesized. This paper presents a concise overview of laws and policies addressing rehabilitation in five European countries. Methods: Publicly available laws, policies, and national action plans addressing rehabilitation issues of Sweden, Italy, Germany, the Netherlands and the United Kingdom were reviewed and descriptive documents analyzed. Actions found in national health policies were also evaluated for compliance with the key recommendations specified in the World Health Organization’s Rehabilitation 2030: Call for Action. Results: Across countries, legal and policy approaches to rehabilitation planning varied in scope and reach. While all countries entitle citizens to rehabilitation services, comprehensiveness of coverage varied. Health legislation of Germany and Netherlands recognizes access to rehabilitation as a human right for persons with disabilities, while Sweden and the United Kingdom acknowledge its importance in disability laws for achieving substantive equality for persons with disabilities. Regarding policies, in all countries but Italy, targeted universalism remains the predominant strategy governing rehabilitation services, as demonstrated by the lack of comprehensive, national action plans for rehabilitation addressing the general population. Nevertheless, references found in disease specific policies indicate a solid consensus that rehabilitation remains an integral component of the care continuum for those experiencing disability. Conclusion: Although a universal approach to rehabilitation coverage is institutionalized in national legislation of the countries examined, this approach is not expressed in formal policies. Targeted strategies aiming to ensure access to subpopulation groups with higher perceived needs for rehabilitation prevail, indicating a strong political will towards the reduction of health inequalities and the promotion of human rights of people experiencing disability. Results obtained from conducting this descriptive review provide the basis for future appraisals of the situation regarding rehabilitation service and policy development in Europe.

Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators

“…Other research has identified disparities in rehabilitation service utilisation for older people based on SES and the need for strategies to address underserved populations with unmet rehabilitation needs (Gell et al., 2017). Rehabilitation programs often use a disease specific model, where rehabilitation programs are siloed by health condition (Garg et al., 2020; Kamenov et al., 2019), excluding people with multimorbidity and frailty (Barker et al., 2018; Carlesso et al., 2020). Focusing on addressing the functional limitations, rather than on disease specific programs, could better address the needs of older people with complex conditions (Beard & Bloom, 2015).…”

“…Key stakeholders acknowledged access to community rehabilitation services for older people was limited. Garg et al (2020) studied health law and policy in Germany, Netherlands, Sweden,…”

“…Focusing on addressing the functional limitations, rather than on disease specific programs, could better address the needs of older people with complex conditions (Beard & Bloom, 2015). Targeted universalism was the predominant strategy governing rehabilitation services in Germany, Netherlands, Sweden, Italy and the United Kingdom, with a lack of comprehensive, national action plans for rehabilitation addressing the general population (Garg et al, 2020).…”

“…This includes strengthening rehabilitation planning and implementation, improving integration of rehabiliation into the health system and incorporating rehabilitation into UHC (WHO, 2017) across care settings and geographies (Briggs & Dreinhöfer, 2017; Cieza et al., 2020; Kamenov et al., 2019). Although the challenges are global in nature, addressing the WHO recommendations requires understanding local contexts to support the design and implementation of local solutions (Briggs & Dreinhöfer, 2017; Garg et al., 2020). This study offered insights into strengths and barriers of existing community rehabilitation policies, programs and services that would support ongoing system development of community rehabilitation services in this context.…”

“…These reforms support the preferences of older people to stay in their homes (Becker, 1994;Stones & Gullifer, 2017). Despite these efforts, the integration of rehabilitation services for older people in healthcare reforms is not well articulated (Berglund et al, 2015;Garg et al, 2020;Harnett et al, 2020). The World Health Organization (2017) acknowledged that health systems needed to strengthen rehabilitation services planning and incorporate rehabilitation services into universal health coverage (UHC).…”