Older people unduly hit by healthcare cuts

In the wake of the economic and financial crisis, many European governments have cut spending on healthcare services. However, at the same time, there is an increased need for these services due to the higher unemployment and financial strain experienced by many households. Given that older people generally have greater healthcare needs than younger people, it seems that this group has been disproportionately affected by the cuts.

Findings from Eurofound’s report Access to healthcare in times of crisis have confirmed the link between reduced healthcare provision post-crisis and older people. The report examined a wide range of healthcare services across the EU, including nursing home care, outpatient and community care and emergency services. Using case studies from healthcare providers in 11 EU Member States – Bulgaria, Greece, Hungary, Ireland, Latvia, Luxembourg, Portugal, Romania, Slovenia, Spain and Sweden – the report describes how these services did their best to maintain access despite the cuts.

Cuts in funding

For example, in Ireland, while the funding for home care (including home help, nursing and physiotherapy) was reduced – the total number of hours of service provision falling from 13 million in 2008 to 9 million in 2013 – the number of people receiving home care increased from 9,000 to 11,000. In Hungary, the budget for home healthcare was cut by 3.9% in 2009 and by 9.3% in 2010, resulting in a decrease in the number of visits per patient, down from 26 in 2007 to 23 in 2012.

Other population groups affected by the crisis in terms of access to healthcare include those in the ‘twilight zone’: people earning too little to be able to access healthcare but whose income is above the threshold for support. In some countries (such as Greece, Ireland and Slovenia) many people have had to cease paying complementary private insurance, because they can no longer afford it.

Issues highlighted in the report

Waiting lists 

While the waiting lists for nursing care should have increased with population ageing and reduced supply, demand has actually gone down in some countries such as Hungary and Latvia. This is because pensions have become an important source of household income due to employment loss post-crisis.

Cutting costs

Some nursing homes have succeeded in maintaining their services by cutting costs in some areas. One example highlighted in the research is a nursing home in Latvia that was able to continue providing its services by economising on its catering facilities, as well on as its psychiatrist and physiotherapist services.

Demand from new clients

There is increased demand on healthcare providers coming from older people who would have previously turned to other services or who find themselves in poverty never before experienced. One example is the case of a hospital in Ireland that set up a community taskforce charged with developing innovative response to keep older people out of the hospital and to shorten their in-patient stays.

Shift towards community care

Generally, the crisis has provided an opportunity for governments and service providers to accelerate the shift from in-patient care toward alternative options in the community, at lower cost and with better quality of life for older people. While this has indeed happened in some examples described in the report, some have moved in an opposite direction because out-patient services were easier to cut than in-patient services. However, the report argues that the crisis is not the ideal context for such a shift, given the lack of resources to plan and design alternative services.

Impact of reduced provision

Policymakers and service providers should be aware of the unexpected or indirect consequences of reductions in healthcare, and the downside of the crisis even where no cuts have been made. In some countries, demand for healthcare in nursing homes has declined because the pensions of elderly relatives are an important source of household income (Hungary, Latvia). In some cases, people have moved from private to public healthcare, creating increased demand (Greece, Ireland, Slovenia), while in others private hospitals have gained more clientele, partly as an indirect consequence of the crisis (Bulgaria, Romania, Sweden).