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.
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.
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DOI：
10.1186/s12939-017-0679-7
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发表时间：
2017-10-25
影响因子：
4.8
通讯作者：
Krafft T
中科院分区：
文献类型：
--
作者：
Doetsch J;Pilot E;Santana P;Krafft T
葡萄牙最近的经济和金融危机促使葡萄牙政府于2011年4月向三驾马车紧缩纾困计划请求财政援助，以获得对其政府债务的援助。三驾马车协议包括葡萄牙的卫生改革和国家卫生服务的紧缩措施，以节省非必要的卫生保健费用。本研究旨在确定受经济危机和三驾马车协议影响的老年人口（65岁及以上）获得医疗保健的潜在障碍，该协议侧重于葡萄牙里斯本大都市区特定经济政策条件谅解备忘录（MoU）。质性研究包括13个半结构式访谈的医疗专家，市政当局，医疗服务提供者，谈判的三驾马车协议，医院管理者，卫生经济学家和老年人。使用Nvivo 2011软件进行内容分析以评估访谈。所确定的障碍集中在Levesque等人提出的“关于获得医疗保健的概念框架”的五个领域（Int J Equity Health 12：18，2013）。老年人获得保健服务的机会在该框架的四个方面不足：可获得性;适当性;可接近性;和可负担性。关于可接受性的第五个领域没有确定，因为这项研究既没有遵循性别也没有遵循种族的具体目的。查明的主要障碍是：目前的财政状况和养恤金削减;初级保健供应不足和使用者费用增加;医院护理服务的设计和提供不足;缺乏长期护理设施;自付药品费用增加;豁免津贴有限;非紧急医疗运输减少;选择性手术等待时间增加;老年人居住条件差。作为三驾马车协议的一部分实施的谅解备忘录中的卫生改革和卫生预算削减与老年人口在获得医疗保健服务方面日益加剧的卫生不平等有关。大多数答复显示，整个国民保健服务（NHS）在为老年人提供充分护理方面，不同保健部门之间的合作、整合和沟通日益不足。这意味着迫切需要调整保健系统，以适应老年人口。
The 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. The 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). Healthcare 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. The 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.
影响因子：
4.2
作者：
Afonso, Alexandre;Zartaloudis, Sotirios;Papadopoulos, Yannis
通讯作者：
Papadopoulos, Yannis