The Evolution and Everyday Practice of Collective Patient Involvement in Europe

Abstract

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4. Migrants’ Consumption of Healthcare Services in Norway: Inclusionary and Exclusionary Structures and Practices

“…Long-term institutional care for older or disabled people requires high cost-sharing and co-payment levels are income tested (Ringard et al, 2014). Although it is difficult to estimate the future use of nursing homes and home healthcare services, some studies suggest that Norwegian municipalities need to prepare for increased demand for care services from elderly migrants (Helse og omsorgsdepartementet, 2013b;Ingebretsen, 2011;Nergård, 2009). Furthermore, a report from 2008 on migrants' use of care services reveals that, compared to the entire older population, only 2.5 percent receives practical assistance and 3 percent home healthcare.…”

“…Regional boards are responsible for management of hospitals and the municipalities for community-based health care (Haarmann, 2018). While hospitals are mainly responsible for acute and specialized health care services, the municipalities provide health care suitable for early identification and follow-up of somatic and mental health (Helsedirektoratet, 2009(Helsedirektoratet, , 2015. The vast majority of the 15% of health expenditure that is privately financed comes from households' out-of-pocket payments.…”

“…The Norwegian authority's ambition is that public services should contribute to the levelling of social and economic differences, and that all citizens should be offered equal quality health care services (Helse og omsorgsdepartementet, 2013b). At the same time, developing accessible, appropriate, and effective services for the migrant population poses a challenge for health care systems in host countries (Czapka & Sagbakken, 2016).…”

Federative patient organizations in a decentralized health-care system: A challenge for representation?

“…The relationship between democracy and representation has even been expressed in terms of a paradox, emphasizing that institutions of representation contain the exclusion of voices just as much as the inclusion of voices (Disch, 2012;Pitkin, 2004). In the policy area of health care, the inclusion of voices and values of the public through deliberation has increasingly become emphasized, for example, in the United Kingdom, the Netherlands, Belgium, and Austria (Cleemput et al, 2015;Haarmann, 2018;Martin, 2008;Tritter, 2009). This representation does, however, entail challenges as well, and critics question, for instance, the selection of representatives and the representativeness of an individual patient (Torjesen et al, 2017).…”

Getting involved: the extent and impact of patient and public involvement in the Swedish health system

“…Simultaneously, it is common the insured in the health insurance funds participate (Wildner e t al ., 2004), and in Germany, in particular, patient involvement through self-help groups (Forster and Kranich, 2007; Härter et al ., 2011) has developed significantly at the national level and the level of federal states (Kofahl et al ., 2014) and gained increasing influence in the decision-making bodies of the SHI system (Busse and Blümel, 2014; Rojatz and Forster, 2017). As in Sweden, collective patient engagement in Germany is focused at the policy level, while it is focused at the provision level in the Netherlands and in England (Haarmann, 2018); illustrating crossovers between NHS and SHI systems in terms of involvement.…”