Challenges and prospects in the EU: Quality of life and public services Chapter 2

21 Introduction The European Commission and European Council’s Joint Employment Report (2018a) notes that, as the EU population ages, demands for healthcare are growing and needs are changing. It sets as a guiding principle for Member States that access to quality healthcare and its effectiveness should be improved. The 2017 European Pillar of Social Rights calls for universal access to high-quality healthcare. In particular, it emphasises the importance of preventive healthcare. Access to quality healthcare and preventive care play important roles in reducing health inequalities (European Commission, 2014). The Annual Growth Survey (AGS) is the first step in the European Semester process leading to annual country-specific recommendations (CSRs) by the European Commission to the Member States. The most recent AGS (European Commission, 2018b) emphasises the importance of good access to quality healthcare services for social inclusion, as well as the need for sustainability of these services in the context of an ageing population. It also calls for a greater focus on prevention. However, the Communication on the CSRs for 2019 (European Commission, 2019) reflects concern that progress has been slow in implementing CSRs in some areas, notably health and long-term care. The 2019 CSRs include recommendations to improve effectiveness, accessibility and sustainability of healthcare for more than half of the Member States. There is great diversity in healthcare systems across the EU. The focus in this chapter is on messages that apply across these diverse systems, drawing on previous Eurofound findings and complemented by new analysis and discussion. The chapter is structured under general headings of access, quality, prevention, sustainability and improving survey data for policymakers. After some general coverage of these broad themes, sections focus on specific issues emerging from Eurofound’s research that have received less attention elsewhere. Access More than 8 out of 10 (82%) people in the EU reported using healthcare services in 2016, ranging from 45% in Romania to 96% in Luxembourg (EU-SILC 2016). EQLS data indicate that even if individual respondents had not used healthcare services themselves, it is likely that someone else in their household had: about half of those who did not use primary, hospital or specialist healthcare services themselves in 2016 reported that someone else in their household had done so. EQLS data further reveal that this contact with healthcare services mainly involves primary healthcare and that most people are highly satisfied with this type of service (Eurofound, 2017a). On a scale from 1 to 10, 73% of people in the EU rated primary care services at 7 or above, and 54% rated these services at 8 or above. Still, many people face access problems. Often these are financial. A spectrum of issues has been reported: not attending healthcare because of inability to pay; postponing care for financial reasons; finding it difficult to access care because of cost; and expecting difficulties if care should be needed (Eurofound, 2019). But difficulties with access to care go beyond financial problems alone (Eurofound, 2013). There may be physical barriers due to distance from the service provider, reachability of the provider or accessibility of the venue. Barriers may also relate to lack of timely access due to waiting times for appointments and referrals, waiting periods at the location of the healthcare provider and opening hours of the service. Here the focus is on ‘informed access’: how far the integration and clarity of the system facilitates prompt access to the most appropriate services. Subsequently, a group in a vulnerable situation is highlighted: people who are in the ‘twilight zone’. Ensuring prompt access to the right services Timely access to good-quality services can prevent people from attending care that is more expensive and less appropriate. However, case studies in Portugal show that sometimes people attend primary healthcare services because they experience poverty and seek support (Eurofound, 2014). Social isolation or lack of access to home care or help at home can also cause people to turn to primary care even when their needs may be better addressed by other services. Another example concerns reports from across the EU of people with debt problems attending mental healthcare services because they lacked access to debt advisory services or debt settlement procedures which could address their situations on a more structural level (Eurofound, 2012). Similar mismatches can be identified within the healthcare system itself. For instance, where primary care is less accessible, people have turned to emergency care for entry into the healthcare system, because co-payments are lower or less likely to be enforced, or opening hours are better (Eurofound, 2014). 2 Healthcare services: Access and quality