Gaps in coverage and access in the European Union

Palm, Willy; Webb, Erin; Hernández-Quevedo, Cristina; Scarpetti, Giada; Lessof, Suszy; Siciliani, Luigi; Ginneken, Ewout van

doi:10.1016/j.healthpol.2020.12.011

Cited by 27 publications

(19 citation statements)

References 14 publications

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“…Besides the limited awareness for infertility treatment and STD prevention in Romania, compared to other European Union countries [ 38 , 39 , 40 ] due to economic and political factors, the state funding for ART is lower than the average of the EU. However, a further country-wide investigation is required to determine the real numbers of average completed fertility treatments, childlessness, and singleton Romanian families, as the latest UNICEF report warns about Romania [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Stress and Financials on Romanian Infertile Women Accessing Assisted Reproductive Treatment

Margan

Fira-Mladinescu

et al. 2022

IJERPH

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Around 20% of couples worldwide are affected by infertility issues, with numbers in the European Union reaching as high as 25%, while access to reproductive care varies significantly by geopolitical and country-specific variables. The purpose of this research is to shed light on the unique social, psychological, and financial difficulties faced by Romanian couples seeking access to assisted reproductive therapy (ART). A cross-sectional study was conducted between 2017 and 2019 to involve women who accessed ART at fertility clinics in Romania by completing two infertility surveys. We analyzed the data in terms of all facets of infertility and ART, including the effect of personal background and stress levels on succeeding to conceive, the impact of treatment costs, and household income. A total of 829 participants completed the survey. We observed that high stress exposure leads to a substantially higher duration to conceive using ART, although the proportions of successful pregnancies did not differ between low-stress and high-stress groups. A significantly higher number of couples achieved pregnancy when their monthly household income was higher than EUR 1000 and if the ART method was more expensive. Additionally, we observed that advanced age, high stress levels, and the high cost of ART had a negative association with achieving pregnancy using ART. The findings indicated that Romanian couples experiencing infertility must contend with significant expenses for specialist infertility treatments, as well as treatment-related stress, both of which have a detrimental effect on their odds of attaining conception.

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Section: Discussionmentioning

confidence: 99%

Impact of Stress and Financials on Romanian Infertile Women Accessing Assisted Reproductive Treatment

Margan

Fira-Mladinescu

et al. 2022

IJERPH

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“…Overall, dental care seems to be subject to more cost-sharing and restrictions compared to other health care areas. This results in limited nancial protection for the costs of oral health care in many countries (see also [10]) and nancial hardship for households impacting on the use of dental care. When comparing unmet needs for different types of care (medical care or prescribed medicines), dental care is the most frequent type of care that people forego due to nancial reasons.…”

Section: Discussionmentioning

confidence: 99%

“…To compare coverage and access to dental services included in each vignette, we use the framework of the Gaps in Coverage and Access survey [10,24] which explores the three traditional dimensions of coverage (population coverage, service coverage (which bene ts are covered) and cost coverage (what proportion of costs is covered)) as well as a fourth dimension, labelled service access. Population coverage was not listed separately for this work, as gaps in statutory health coverage would be picked up under the service coverage dimension.…”

Section: Approach and Conceptual Frameworkmentioning

confidence: 99%

“…In terms of service access, gaps could be due to i) lack of physical availability of services, due to long distances to the provider, lack of su cient statutory/contracted providers, poor quality of services, limited opening hours, waiting times and waiting lists; ii) lack of person's ability to obtain necessary care, due to a person's incapacity to formulate care request, obtain the care or to apply for coverage (and ful l the necessary requirements) due to their condition or situation (e.g. people with cognitive impairment, mentally ill, homeless), and ability to navigate the system (for example when referred from one provider to another one); and iii) attitude of the provider, for example due to discrimination (on age, gender, race, religious beliefs, sexual orientation, etc) leading to care denial or inability to accommodate care to the patient's preferences [10]. Furthermore, a list of determinants that could improve or worsen access, including patient characteristics (e.g.…”

Section: Approach and Conceptual Frameworkmentioning

confidence: 99%

“…This leads to inequalities in access to dental health services within and across countries and eventual inequities in oral health status [5,[7][8][9]. A 2019 survey on areas of care where access might be a problem in European countries identi ed oral health as one area with major gaps in coverage and access [10].…”

Section: Introductionmentioning

confidence: 99%

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Exploring Variation of Coverage and Access to Dental Care for Adults in 11 European Countries: A Vignette Approach

Winkelmann¹,

Rossi²,

Schwendicke³

et al. 2021

Preprint

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Background: Oral health has received increased attention over the past few years coupled with rising awareness on the impact of limited dental care coverage for oral health and general health and well-being. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach.Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists.Results: Completed vignettes were received from 11 countries, including Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different kinds of physical barriers to access dental care. Major access barriers to public dental care represent the limited availability of contracted dentists especially in rural areas and the unequal distribution and lack of specialised dentists.Conclusions: According to the results, statutory coverage of dental care varies across European countries while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries which in turn leads to high out-of-pocket spending. The individual socioeconomic status is thus a main determinant for access to dental care, but also other factors such as geography, age and comorbidities can inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.

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Effects of a statutory reform on waiting times for outpatient psychotherapy: A multicentre cohort study

Schnittger

Engesser

Wirp³

et al. 2022

Couns and Psychother Res

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Aims: Social inequality in access to mental health care is a current concern across the world. The authors determined whether differences in waiting times for outpatient psychotherapy changed after a statutory reform of the German psychotherapy law. Methods:The dates of first contact, first visit and treatment start, along with sociodemographic and clinical data, were extracted from patient records in communitybased psychotherapy practices. Predictors of waiting times for first visit and treatment start were investigated using multilevel Cox regression models to estimate adjusted hazard ratios (HR adj ).Results: Data from 1548 patient records from nine practices were extracted. Before the reform, the time span between first contact and first visit was longer for patients with compulsory education than for patients with a college degree (HR adj 0.8, 95% CI 0.6-1.0), whereas this was no longer the case after the law changed (HR adj 1.0, 95% CI 0.8-1.3). Patients whose treatment was covered by the state were at higher risk of a long waiting time from last visit to treatment start compared with patients with statutory health insurance after the law changed (HR adj 0.4, 95% CI 0.3-0.7), which had not been the case before the law changed (HR adj 1.3, 95% CI 0.8-2.2).Conclusions: Social inequality in access to psychotherapy was reduced in part by the updated psychotherapy law in terms of educational groups; however, it increased in other aspects. This shows how political decisions can powerfully impact clinical practice, ultimately helping one group of patients while disadvantaging another.

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Gaps in coverage and access in the European Union

Cited by 27 publications

References 14 publications

Impact of Stress and Financials on Romanian Infertile Women Accessing Assisted Reproductive Treatment

Impact of Stress and Financials on Romanian Infertile Women Accessing Assisted Reproductive Treatment

Exploring Variation of Coverage and Access to Dental Care for Adults in 11 European Countries: A Vignette Approach

Effects of a statutory reform on waiting times for outpatient psychotherapy: A multicentre cohort study

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