Tuesday, October 11, 2011

[EQ] Addressing inequities in access to health care for vulnerable groups in countries of the European region

Addressing inequities in access to health care for vulnerable groups in countries of the European region

Xenia Scheil-Adlung, Health Policy Coordinator, ILO, Social Security Department

Catharina Kuhl, ILO Consultant
GESS Global Extension of Social Security - International Labor Organization ILO, 2011


Available online PDF file [39p.] at: http://bit.ly/n9MfnI

 

“……Europe as a whole is often perceived as a group of wealthy countries where inclusive social protection systems provide comprehensive protection for the most vulnerable and health care at highest standards is easily accessible for everybody. Thus, persisting gaps in social health protection coverage and inequities in access to health services experienced by vulnerable groups receive only little attention and are rarely adequately analysed with regard to specific aspects such as gender, migration, or issues related to ethnic groups.

As a result, in times of financial constraints, policy discussions often turn around to cut back social protection expenditures without sufficiently investigating the impacts on those in need. The austerity programmes of the EURO debt crisis may serve as one of the most recent illustrations of such policies within the European Union. A further example of inadequate attention to inequities in access to health care is the negligible amount of donor aid for health in Europe, which at merely 0.34 US$ per capita is almost inexistent for many CEE/CIS countries2, despite documented challenges of achieving the Millennium Development Goals (MDGs) by 2015 in many countries of the broader European region.3

Against this background, this paper highlights issues that contribute to persisting inequalities in access to health care of vulnerable groups in the broader European region, including countries of the European Union (EU), the Commonwealth of Independent States (CIS), Central and Eastern Europe (CEE), and selected countries of Central Asia.

 

We focus on key determinants of vulnerability, primarily labour market impacts such as income, employment, and related gaps in access to social protection, and to social health protection in particular. Moreover, we concentrate on stratification of vulnerability looking at specific population groups, including women, the elderly, migrants, and ethnic groups, mainly Roma, who are often disadvantaged in regard with determinants of vulnerability as focused on here (Figure 1). Special attention is also given to rural and urban inequities.

First, we present the main characteristics of social health protection systems in countries of the European region regarding financing, organization, and benefit arrangements. We then analyze remaining gaps in social health protection in terms of legal coverage, financial protection and geographic availability of health services, and the impact on effective access for vulnerable groups…..”

 

Content:

1. Introduction

2. Main characteristics of social health protection systems in the European region

3. Determinants of inequities in access to health care due to gaps in social health protection

3.1. Gaps in legal coverage

3.2. Limitations in the scope of benefits

3.3. Gaps in financial protection

3.4. Geographical inequalities in access

4. Determinants of inequities in access to health care due to the socio-economic environment

4.1. Economic context and progress towards the MDGs in poverty, gender equality and health

4.2. Employment and the labour market structure

4.2.1. Female labour participation

4.2.2. Labour market structure

4.3. Income disparities

4.4. Poverty

4.5. The broader social protection system

5. Addressing inequities in access to health care for vulnerable groups

5.1. Extending coverage and effective access in social health protection

5.2. Addressing wider socio-economic inequalities with the social protection floor approach

6. Conclusions

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
Washington DC USA

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Migrants in an irregular situation: Access to healthcare in 10 European Union Member States

Migrants in an irregular situation:
Access to healthcare in 10 European Union Member States

11 October, 2011 - European Union Agency for Fundamental Rights (FRA)

            Available online PDF file [68p.] at: http://bit.ly/p64dvg


           

This report documents the legal, economic and practical obstacles that hinder irregular migrants' access to healthcare. 

“…..This research includes in-depth interviews with irregular migrants, public authorities, healthcare staff and civil society organisations in 21 cities in 10 Member States (Belgium, France, Germany, Greece, Hungary, Ireland, Italy, Poland, Spain and Sweden).

 

The report found several barriers to accessing healthcare for migrants in an irregular situation, that is, non-nationals present in an EU Member State without a visa or residence permit:

·         Irregular migrants – who are not usually permitted to work – are often required to pay for medical care that is available cost-free to nationals. This includes emergency medical care, as well as antenatal, postnatal and delivery care for pregnant women and healthcare for children.

·         The risk of possible deportation deters irregular migrants from seeking even emergency healthcare. In some EU Member States, a policy or practice exists of reporting irregular migrants to immigration authorities when they access health services.

 

The report suggests several ways forward:

·         Access to necessary healthcare should be made available cost-free to irregular migrants on the same basis as nationals. Children should have equal access to healthcare, and pregnant women should have access to services for antenatal and postnatal care, and for delivery.

·         Healthcare authorities should not be placed under a duty to report migrants in an irregular situation to immigration authorities, and such practices should be discontinued.

This report is the second of three on the fundamental rights of irregular migrants in the EU. The report Migrants in an irregular situation employed in domestic work, was launched in July of this year. The comparative report on ‘Fundamental rights of migrants in an irregular situation in the European Union’ will be launched at FRA’s 2011 Fundamental Rights Conference addressing ‘Dignity and rights of irregular migrants’ to be held on 21-22 November 2011in Warsaw….”

 

Content:

 

EXECUTIVE SUMMARY

OPINIONS

INTRODUCTION

1. .THE NATIONAL LEGAL FRAMEWORK

1.1. General entitlements to healthcare

1.2. Entitlements for specific diseases

1.3. Entitlements for specific groups

2. .REGIONAL AND LOCAL HEALTH POLICIES

3. .THE EFFECTS OF EXCLUSION FROM HEALTHCARE

4. PRACTICAL OBSTACLES AND CHALLENGES

4.1. Costs and reimbursements

4.2. Unawareness of entitlements

4.3. Reporting migrants to the police

4.4. Discretionary power of public and healthcare authorities

4.5. Quality and continuity of care

CONCLUSIONS

ANNEXES .

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 *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
Washington DC USA

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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Blog SDOH: http://bit.ly/nA9cdx

================= The information contained in this electronic message and any attachments are intended for specific individuals or entities, and may be confidential, proprietary or privileged. If you are not the intended recipient, please notify the sender immediately, delete this message and do not disclose, distribute or copy it to any third party or otherwise use this message. The content of this message does not necessarily reflect the official position of the International Organization for Migration (IOM) unless specifically stated. Electronic messages are not secure or error free and may contain viruses or may be delayed, and the sender is not liable for any of these occurrences.



IMPORTANT: This transmission is for use by the intended
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confidential information. If you are not the intended
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transmission to the intended recipient, you may not
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any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.