The Challenges of Service Provision

Swift, Cameron; Severs, Martin

doi:10.1093/ageing/26.suppl_4.30

Cited by 3 publications

(1 citation statement)

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“…The increasing number of older people associated with demographic ageing of the Social Science & Medicine 50 (2000) 1025±1036 0277-9536/00/$ -see front matter # 2000 Elsevier Science Ltd. All rights reserved. PII: S 0 2 7 7 -9 5 3 6 ( 9 9 ) 0 0 3 5 2 -4 www.elsevier.com/locate/socscimed population is currently a major concern in Europe and Portugal (Grundy, 1996;Stolnitz, 1996;Watson, 1996), particularly in terms of the health care oered, consumption of health care services (Coleman, 1995;Impallomeni and Starr, 1995;Santana, 1995) and health care expenditures (Taylor and Gooby, 1996;Swift and Severs, 1997). In the United States, Longino (1997, p. 841) has clearly made the point that the culture of medicine is changing, and this change is likely to escalate because of the growth and ageing of the US retirement-age population, the ampli®cation of chronic, rather than acute, illness that accompany ageing, the broad range of noninstitutional options for long-term care, and the interdisciplinary nature of geriatric.…”

Section: Introductionmentioning

confidence: 99%

Ageing in Portugal: regional iniquities in health and health care

Santana¹

2000

Social Science & Medicine

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The health of the Portuguese has improved considerably in the last twenty years. Economic and social transformations that have contributed to the progressive amelioration of problems of feeding, sanitation, hygiene, housing and social conditions in general, as well as health services, have had decisive effect on this phenomenon. The spectacular regression of the indicators related to transmitted diseases, infant, perinatal (more than 50% between 1985 and 1994) and maternal mortality, and the mortality of children 1 to 4 yr old, also reflects this impact. The positive changes that took place in health indicators were reflected in the growth of life expectancy at birth (2.2 yr more for male and 2.3 more for women between 1985 and 1994) in spite of the fact that the difference in life expectancy in relation to EU countries has grown. Improvement in life expectancy, especially in the older age groups, is not normally associated with significant reductions in morbidity. In fact, increased longevity has become more generally associated with chronic illness or other disabilities requiring more medical services and other forms of personal care. This paper reviews some of the evidence for regional differences in the health status of elderly people in Portugal and considers how health services have reacted to these differences. A preliminary study of health status and patterns of utilisation of elderly people was undertaken. After 30 yr of a National Health Service (NHS) in Portugal we may ask why do inequities in health and access to health care of the elderly population persist? Proactive policies to prevent illness and promote health are still relatively underdeveloped in the Portuguese NHS, and the factors that influence health, such as housing, diet and occupational health hazards, remain largely absent from health and welfare policies. Poor accessibility to health services is the most serious barrier consumers have to face in order to get a medical appointment, and this is more relevant to the oldest part of the population. Geographical location of health care facilities unequally affects the ease of access of different groups of consumers and influences utilisation patterns. Examining the distribution of health services resources is an important way to understand the inequities of access to health and to health care.

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