Faculty of Health, Medicine and Life Sciences (FHML), School of Public Health and Primary Care (CAPHRI), Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands.
Centre of Studies on Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal.
Int J Equity Health. 2017 Oct 25;16(1):184. doi: 10.1186/s12939-017-0679-7.
The recent economic and financial crisis in Portugal urged the Portuguese Government in April 2011 to request financial assistance from the troika austerity bail out program to get aid for its government debt. The troika agreement included health reforms and austerity measures of the National Health Service (NHS) in Portugal to save non-essential health care costs. This research aimed to identify potential barriers among the elderly population (aged 65 and above) to healthcare access influenced by the economic crisis and the troika agreement focussing on the Memorandum of Understanding on Specific Economic Policy Conditionality (MoU) in Lisbon metropolitan area, Portugal.
The qualitative study is including 13 semi-structured interviews of healthcare experts, municipality authority, health care providers, negotiator of the troika agreement, hospital managers, health economists and elderly. A content analysis was performed to evaluate the interviews applying Nvivo2011 software. The barriers identified were clustered towards the five areas of the 'Conceptual framework on health care access' by Levesque et al. (Int J Equity Health 12:18, 2013).
Healthcare access for the elderly was found inadequate in four areas of the framework: availability; appropriateness; approachability; and affordability. The fifth area on acceptability was not identified since the study neither followed a gender nor ethnic specific purpose. The main identified barriers were: current financial situation and pension cuts; insufficient provision and increased user fees in primary care; inadequate design and availability of hospital care service; lack of long-term care facilities; increased out-of-pocket-payment on pharmaceuticals; limitations in exemption allowances; cuts in non-emergent health transportation; increased waiting time for elective surgery; and poor unadapted housing conditions for elderly.
The health reforms and health budget cuts in the MoU implemented as part of the troika agreement have been associated with increasing health inequalities in access to healthcare services for the elderly population. The majority of responses disclosed an increasing deficiency across the entire National Health Service (NHS) to collaborate, integrate and communicate between the different healthcare sectors for providing adequate care to the elderly. An urgent necessity of restructuring the health care system to adapt towards the elderly population was implied.
葡萄牙最近的经济和金融危机促使葡萄牙政府于 2011 年 4 月请求三驾马车紧缩救助计划提供财政援助，以帮助其偿还政府债务。三驾马车协议包括对葡萄牙国家卫生服务（NHS）进行卫生改革和紧缩措施，以节省非必要的医疗保健费用。本研究旨在确定由经济危机和三驾马车协议引起的、老年人（65 岁及以上）获得医疗保健服务的潜在障碍，重点是葡萄牙里斯本大都市区谅解备忘录（MoU）中的具体经济政策条件（MOC）。
本定性研究包括对医疗保健专家、市当局、医疗保健提供者、三驾马车协议谈判代表、医院经理、卫生经济学家和老年人进行的 13 次半结构化访谈。采用 Nvivo2011 软件对访谈内容进行分析。根据 Levesque 等人（Int J Equity Health 12:18, 2013）的“医疗保健获取概念框架”，将确定的障碍分为五个领域。
老年人的医疗保健获取在框架的四个领域被认为是不充分的：可得性；适宜性；可接近性；和可负担性。由于研究既没有遵循性别特定目的，也没有遵循种族特定目的，因此没有确定第五个可接受性领域。主要确定的障碍包括：当前的财务状况和养老金削减；初级保健中提供的服务不足和增加用户费用；医院服务设计和可用性不足；缺乏长期护理设施；药品自付费用增加；豁免津贴限制；非紧急医疗运输减少；择期手术等待时间延长；以及老年人住房条件差。
作为三驾马车协议的一部分实施的 MoU 中的卫生改革和卫生预算削减，与老年人获得医疗保健服务的健康不平等状况增加有关。大多数受访者表示，整个国家卫生服务（NHS）在不同医疗保健部门之间的合作、整合和沟通方面都存在越来越多的不足，无法为老年人提供足够的护理。暗示需要紧急调整医疗保健系统，以适应老年人口。
