Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: a qualitative case study in Lisbon, Portugal

Abstract

BackgroundThe recent economic and financial crisis in Portugal urged the Portuguese Government in April 2011 to request financial assistance from the troika austerity bail out program to get aid for its government debt. The troika agreement included health reforms and austerity measures of the National Health Service (NHS) in Portugal to save non-essential health care costs. This research aimed to identify potential barriers among the elderly population (aged 65 and above) to healthcare access influenced by the economic crisis and the troika agreement focussing on the Memorandum of Understanding on Specific Economic Policy Conditionality (MoU) in Lisbon metropolitan area, Portugal.MethodsThe qualitative study is including 13 semi-structured interviews of healthcare experts, municipality authority, health care providers, negotiator of the troika agreement, hospital managers, health economists and elderly. A content analysis was performed to evaluate the interviews applying Nvivo2011 software. The barriers identified were clustered towards the five areas of the ‘Conceptual framework on health care access’ by Levesque et al. (Int J Equity Health 12:18, 2013).ResultsHealthcare access for the elderly was found inadequate in four areas of the framework: availability; appropriateness; approachability; and affordability. The fifth area on acceptability was not identified since the study neither followed a gender nor ethnic specific purpose. The main identified barriers were: current financial situation and pension cuts; insufficient provision and increased user fees in primary care; inadequate design and availability of hospital care service; lack of long-term care facilities; increased out-of-pocket-payment on pharmaceuticals; limitations in exemption allowances; cuts in non-emergent health transportation; increased waiting time for elective surgery; and poor unadapted housing conditions for elderly.ConclusionsThe health reforms and health budget cuts in the MoU implemented as part of the troika agreement have been associated with increasing health inequalities in access to healthcare services for the elderly population. The majority of responses disclosed an increasing deficiency across the entire National Health Service (NHS) to collaborate, integrate and communicate between the different healthcare sectors for providing adequate care to the elderly. An urgent necessity of restructuring the health care system to adapt towards the elderly population was implied.

Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana

“…This confirms that poor older people experience multiple barriers to accessing formal health services in Ghana. Clearly, the formal health services use barriers among poor older people found in the present study do mirror the barriers mentioned in the literature [27,32,[37][38][39][57][58][59].…”

“…In all, 60 participants comprising 30 poor older people (users), 15 formal healthcare providers and 15 caregivers took part in this study. With regard to users, most (23) of them were females, had no level of education (19), Christians (27) and Akan (25). Regarding the formal healthcare providers, nine were females, 12 each were Christians and Akan and all had attained a tertiary level of education.…”

“…Issues such as financial problems, limited health workforce, and facilities are the major challenges facing the healthcare system in Ghana [25,26]. Consequently, the utilisation of formal healthcare services among older people involves numerous barriers [10,27,28]. These barriers are mostly factors that hinder access to and utilisation of formal healthcare services [29].…”

“…These barriers are mostly factors that hinder access to and utilisation of formal healthcare services [29]. Social, cultural, economic, institutional factors including health illiteracy and language difficulties [27,[29][30][31], geographical distance and transportation problems [10,13,28,[32][33][34], societal cultural norms [35,36] and lack of health insurance [37] impede the use of formal healthcare among older people. Despite the global growth in literature on barriers to formal healthcare use among older people, little is known from the perspective of poor older people in Ghana.…”

Acesso aos cuidados de saúde em Portugal no rescaldo da crise. Nem tudo é dinheiro?

“…Em Portugal, entre 2008 e 2014, triplicou a proporção dos indivíduos mais pobres (primeiro quintil de rendimento) que reportaram necessidades de atenção médica não satisfeitas por razões financeiras 12 e o risco de declarar necessidades não satisfeitas mais do que duplicou em 2012, comparado com 2010 17 . A evidência aponta também para um aumento das barreiras no acesso a cuidados de saúde pelos idosos, na sequência dos condicionalismos associados à intervenção da troika em Portugal 18 . Mas o acesso é um conceito multidimensional, sendo influenciado por diversas variáveis quer do lado da oferta, quer do lado da procura.…”