Access Compromised? The Impact of Healthcare Reforms under Austerity in Lithuania and Spain

Abstract

Using an interpretative comparison in search for cross-case similarities and differences, we examine the evolution of equity of access to healthcare during the economic crisis in two potentially vulnerable Eastern and Southern European countries – Lithuania and Spain. While the type of healthcare system may have shown higher resilience, i.e. equity of access to care during the crisis should have been affected more in Lithuania – a relatively immature health insurance system – than in Spain – a consolidated national health service, the intensity and length of the crisis and types of adjustment measures undertaken may have led, in turn, to different results in terms of equity of access. The analysis focuses on the respective institutional designs and healthcare reforms under austerity as well as subjective and objective indicators of access to care. We conclude that the Lithuanian healthcare system, despite potential comparative disadvantage, has shown greater performance than the Spanish one during the crisis.

Under- or Overtreatment of Mental Distress? Practices, Consequences, and Resistance in the Field of Mental Health Care

“…While this is in line with a low proportion of unmet medical needs in Spain (Doblytė & Guillén, 2020; OECD/EU, 2018; Petmesidou et al, 2019), the analysis of qualitative data reveals the logic of the field and the role of other fields that go beyond accessibility per se and that could explain certain logic of practice and outcomes for individuals and society, all of which are presented in the following sections. It is argued that being able to meet with a health care provider of any type without major barriers may not necessarily mean that individuals receive appropriate care or that those in need access it.…”

“…In light of this, the focus of the article is Spain, where the Financial Crisis that greatly hit South European societies is argued to have had a negative impact on mental health with substantial increases in prevalence of anxiety and depressive symptoms (Chaves et al, 2018; Gili et al, 2012). Yet, high equity of access to the health system in terms of its universality, affordability, and comprehensiveness (Doblytė & Guillén, 2020; Guillén, 2002; Petmesidou et al, 2019) might have helped to reduce negative health outcomes. Mental health care is fully integrated into the Spanish National Health Service that is organized on a gatekeeping basis with accessible and strong primary care.…”

“…All of this results in lower unmet medical needs for health system-related reasons in Spain than the European average (Doblytė & Guillén, 2020; OECD/EU, 2018) and, especially, than in other South European societies (Petmesidou et al, 2019). Unmet needs for mental health care are also estimated to be lower (Alonso et al, 2007) and perceived effectiveness of professional mental help higher (ten Have et al, 2010) than in other Western European countries.…”