A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable

Abstract

Background There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. Objective This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013). Methods This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included. Results The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status. Conclusion Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.

Impact of omitting annual reviews for COPD on patient reported care quality– outcomes from the Asthma+Lung COPD patient passport

“…Cuts to public health and healthcare budgets have a direct effect on service provision and waiting times. Indirect effects, via increasing levels of unemployment, poverty and cost of living, make life more difficult for people with long-term health conditions 11 13. A clear link has been demonstrated between deprivation and living in a cold and or damp house and the likelihood of having frequent acute exacerbations of COPD 6.…”

“…A second question also arises regarding appropriate training, support and equipment, to allow clinicians to ensure they are providing annual reviews which meet the British Thoracic Socitey (BTS) guidelines. The combination of the austerity measures and COVID-19 pandemic has had a huge negative effect on clinical resources and clinical staff time and is likely to contribute to inadequate COPD reviews 11 13 16. Another consideration is the risk that the review becomes a ‘tick box’ exercise limiting the benefit to individual patients?17 18?…”

Access equity: key questions and challenges - A report from the 1st workshop of the European Haemophilia Consortium (EHC) Think Tank Workstream on Access Equity

“…When considering the contribution of behaviour, mindset and incentives to access equity in rare diseases, it is important to look across all stakeholders, notably healthcare providers, policymakers, industry and the patient community. Faced with an ageing population with associated comorbidities and complexities, and with growing healthcare demand, providers and policymakers may adopt a 'savings mindset' and freeze budgets [25] , but this is counterproductive for access equity. Short-termism may mean restricted allocation of funding for innovative and preventive therapies, and resource allocation may occur without detailed knowledge of the issues [26] .…”

“…Short-termism may mean restricted allocation of funding for innovative and preventive therapies, and resource allocation may occur without detailed knowledge of the issues [26] . A behavioural focus on reducing costs while maintaining the current system may result in 'quick fix' decisions being implemented without adequate understanding of potentially adverse long-term implications [25] . This is unhelpful and may be detrimental to access equity.…”

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

“…Multiple studies have reinforced the impact of the economic recession on healthcare systems and their deterioration if austerity measures are imposed, impacting infant mortality rates (IMR) and perinatal mortality rates (PMR) across Europe,11 12 among others, explained by decreased access to healthcare,13–15 increased stress,16 adverse mental health17 18 and unhealthy behaviours (eg, alcohol usage)19 among pregnant women. Previous studies reported that the Great Recession was associated with a significant increase in low birth weight12 and indicated a reverse in downward trends of IMR, PMR and neonatal mortality, mainly determined by long-term unemployment and income reduction11 (countercyclical fluctuation), thus, socioeconomic indicators.…”