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Universal Access to Healthcare for All Ages
1. Universal and Equal
Access to Health-care
Services
Štefan Krajčík
Slovak Medical University
Bratislava, Slovakia
2. Universal and Equal Access
to Health-care Services
Member States of the World Health
Organization (WHO) committed in
2005 to develop their health financing
systems so that all people have access
to services and do not suffer financial
hardship paying for them
Human Development Report 2005
http://hdr.undp.org/en/media/hdr05_summary.pdf
3. Questions on universal
access to healthcare…
Who will this access be for ?
What should be its extent ?
Who will pay for it ?
4. The systems of
healthcare payment
Payment in cash
Payment from taxes
Payment by insurance
Co-payment
5. What is necessary for
universal access?
The key for universal access is
the solidarity of people with
higher incomes with people on
lower incomes and the solidarity
of healthy people with ill people
But how does it work ?
7. Disability
There are 80 million Europeans
with disabilities. This is over
15% of the whole population.
One in four Europeans has a
family member with a disability.
http://www.edffeph.org/PageGenerale.asp?Doc
ID=1254acceseed April 28. 2012
8. Eu
ro
p
Cz ean
0,0
5,0
10,0
15,0
20,0
25,0
ec un
h
Re ion
pu
10,2
b
De lic
nm
6,8
Sl ark
ov
7,9
ak
i
Fr a
14,0
an
c
Gr e
10,0
ee
Hu ce
ng
21,0
Ge ar y
rm
11,0
an
Ire y
5,7
lan
Sl
ov d
14,7
en
i
Po a
8,7
la
Po nd
rtu
10,2
Un Ro gal
ite m
15,0
d K an
in ia
7,1
gd
o
Be m
8,3
lgi
Bu um
lg
7,2
ar
ia
12,4
Ita
l
Unemployment rate in EU (%)
Cy y
pr
Es us
9,3 9,7
to
ni
Fi a
11,7
nla
nd
La
7,5
Li t via
t
Lu hua
xe ni
m a
bo
14,6 14,3
ur
g
5,2
Ma
lta
6,8
9. Low income
The minimum monthly wage in
Slovakia is 327 Euro. The high
unemployment rate increases
the number of people willing to
work for minimal wages.
10. Poverty rate
In 2008, 17% of the population in the EU27
were at risk of poverty.
The highest at-risk-of-poverty rates in 2008
were found in Latvia (26%), Romania
(23%), Bulgaria (21%), Greece, Spain and
Lithuania (all 20%), and the lowest in the
Czech Republic (9%), the Netherlands and
Slovakia (both 11%), Denmark, Hungary,
Austria, Slovenia and Sweden (all 12% )
http://epp.eurostat.ec.europa.eu/cache/ITY_PUBLIC/3-18012010-AP/EN/3-
18012010-AP-EN.PDF
11. Population ageing in
the world
1950 2050
% of people 60+ 8 21
Potential support 12 4
ratio (PSR)
http://www.un.org/es/population/publications/wo
rldageing19502050/pdf/62executivesumma
12. Health care consumption
in old age in the USA in
2010
26 percent of physician office visits
35 percent of hospital stays
34 percent of prescriptions
38 percent of emergency medical
responses
90 percent of nursing home use
http://medical-careers-review.toptenreviews.com/the-
rising-health-care-needs-of-aging-baby-boomers.html
13. Increase of healthcare
costs
Average healthcare spending in
the EU27 will increase from 6.7%
of GDP in 2007 to 7.4% in 2030
and then to 8.4% in 2060.
Przywara, B (2010), Projecting future health care expenditure
at European level: drivers, methodology and main results,
Brussels: European Commission.
14. Solidarity
Insurance for 53% of population in
Slovakia is paid for from the national
budget
Contributions from the state are only
4% of the average wage
(i.e. 31,44 Euro per month)
Contributions of economically active
people are 14% of their income
(110 Euro for average wage)
15. The inbalance of income
and expenditure in Slovakia
The difference between income and
expenditure is about 15 % of income
It increases comparative to the size of
hospital.
A lack of resources erodes the
innovation of technology and
maintenance of buildings. This
concealed debt is estimated to be 1-3
Bn. Euro.
16. Double solidarity
The economically active people
‘show solidarity’ twice at present.
They pay both insurance and taxes.
If the principle of justice should be
preserved it is necessary to secure
health care for current payers when
they are in need of support.
17. Financial stress in
healthcare
More than 40% of specialists worry that
there is not enough healthcare funding
in their country to meet future demands.
One-third say there is less funding
available for all healthcare provision. The
same respondents see ageing as one of
the biggest challenges facing healthcare
systems.
A new vision for old age. Rethinking health policy for
Europe’s ageing society. A report from the Economist
Intelligence Unit
http://www.bgs.org.uk/pdf_cms/pubs/economist_report_o
n_ageing.pdf
19. Lowering cost
Lower costs increase access to a
bigger number of people
Lowering cost of care may be
associated with a lower standard of
care
Efforts to decrease cost can result in
denying more expensive care to
some groups of patients.
20. Is it right ?
The extent of fully-paid health care in
old age will be narrower and
symptomatic treatment will be preferred
to causal. The principle of justice will be
preserved because everybody was young
and had a claim to fully paid health care,
which helped him/her to survive to old
age.
Report on preparedness of health care resort to fulfill concept
of health care- record from the 72th meeting of government,
25thFebr.2004
www.rokovania.sk
21. Myths and truths in using hi-
technology with old people
Using hi-tech equipment to treat wastes resources
and utilities of care in people nearing the end of
their natural life.
Most of the resources spent caring for older people
were spent on nonivasive treatments like medicine,
aids. etc. (Oberlander, 2005)
Hi-tech equipment, e.g. renal replacement therapy,
liver or heart transplantation done in selected older
people are cost-effective modes of treatment (Evans
1991)
Age itself is no contraindication
22. Equity in healthcare
Equity means that everybody
has the right that the provided
care will meet their needs as
much as possible.
24. Know how
„People aged 65 and over account for
70% of bed days in English general
hospitals, but traditional training of
doctors and nurses is still geared up
to a world where it’s all about young
people.”
Professor David Oliver, in A new vision for old age .Rethinking health
policy for Europe’s ageing society. A report from the Economist
Intelligence Unit
http://www.bgs.org.uk/pdf_cms/pubs/economist_report_on_ageing.pdf
25. Services of older people
The nature of conditions affecting
older people requires concomitant
provision both social and health care
and building integrated system of
long term care
Some older people have special
needs
26. Special needs frequent
in old age
Dementia (number of people with
dementia will increase in various
countries by 100 to 300%)
Falls and mobility problems
27. Attitudes
There is a strong discrepancy
between needs and deeds.
The driving force for the
restructuralisation of health care
provision reform is saving money
without the aim of better meeting
the needs of seniors.
28. Attitudes
42% of the respondents believe that
negative attitudes towards older
people constitute the leading barrier
to the provision of better care.
Rethinking health policy for Europe’s ageing society. A report from the
Economist Intelligence Unit
http://www.bgs.org.uk/pdf_cms/pubs/economist_report_on_ageing.pdf
29. Conclusion 1
There is no doubt that some issues
in health care for seniors have
improved but many others give me
concern as a future recipient of care
and fill me with disappointment as
a professional engaged in this field
for 31 years.
30. Conclusion
80% of all health professionals surveyed
are concerned about how they will be
treated when they are older.
A new vision for old ageRethinking health policy for Europe’s ageing
society
A report from the Economist Intelligence Unit
32. This will have an impact on efforts to make
healthcare systems fit for the challenges
ahead. In our survey, 49% of respondents
say that ageing is regarded as a threat to the
viability of their countries’ national
healthcare systems,
but 50% say it provides the opportunity for
broader healthcare reforms, which are
needed anyway
