Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need

Abstract

Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC) system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013) and the Primary Healthcare Activity Monitor for Europe (2010). The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country’s PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce) as this can influence inequity in unmet need.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

“…It distinguished countries with regard to their financing system of health care, as follows (and as already anticipated in Introduction of this paper): NHS (funded primarily by taxation), SIS (funded through social insurance schemes), and TC (including former Eastern Bloc countries with health systems in transition). This classification was further used by Brennan and colleagues [47], with specific regard to eHealth adoption (ii) (Overall) strength of PC: this classification is based on Kringos and colleagues [49,68] and Detollenaere and colleagues [50] who analyzed data from 2009 to 2010. These data were collected as part of the European Union-funded project "Primary Health Care Activity Monitor for Europe -PHAMEU study".…”

“…These data were collected as part of the European Union-funded project "Primary Health Care Activity Monitor for Europe -PHAMEU study". In particular, Detollenaere et al [50] based his own study on the framework (selection of the indicators, data collection, and calculation of the scales) described by Kringos and colleagues [49,68], who distinguished countries with regard to strength (strong, medium, and weak) of their PC. Data included information/subdimensions on both PC structure (governance, e.g., policy implementation; economic conditions, e.g., expenditure/incentives systems; and workforce development, e.g., profile of professionals providing PC) and PC service delivery processes (accessibility, e.g., geographical distribution of services; comprehensiveness, e.g., available medical equipment; continuity, e.g., patient-GP relationship; coordination, e.g., gatekeeping role for GPs; and teamwork).…”

“…Moreover, a strong PC development (e.g., with strong service delivery process and structure) [48] seems linked to the growing possibilities of technology [49]. PC is indeed the first "entry-point" to the health system in many European countries, with a crucial role in coordinating patients throughout the different health settings [50], and a condition for its efficient work is the use of ICT. Living in countries with a strong PC system is in turn beneficial to people with MM [51], as the principles of PC-e.g., continuous, comprehensive, and coordinated care-may fit their needs in a better way [52,53].…”

Primary care workforce development in Europe: An overview of health system responses and stakeholder views

“…NCDs' [12, p.4-5]. Comparative studies have shown that strong primary care systems achieve better health outcomes and better results in relation to both cost-containment and reducing inequality in access to, and accessibility of, care; they also support more effective service utilisation elsewhere in the health system [3][4][13][14][15][16].…”

Free Children’s Visits and General Practice Attendance

“…1,2 In the Republic of Ireland, 55% of all citizens do not qualify for state-funded, means-tested general practitioner care 3 and thus must pay out-of-pocket fees (approximately US$50 to US$65) for each general practice visit. 4 On July 1, 2015, all 440,000 children aged younger than 6 years in the Republic of Ireland were granted free access to general practice visits, regardless of parental income.…”