1.I. Workshop: Capturing access challenges in health care: can the vignette methodology help?

Abstract

Abstract Access to health care is a key performance dimension for health systems. Around 3% of the EU27 population experienced unmet need for health services in 2019 (Eurostat 2021). However, this average hides significant differences across and within countries, between income groups, levels of education and socio-economic categories. While some of the reasons for unmet need are more personal (no time, fear of doctor, etc.), the most common factors are health system-related. Although self-reported unmet need and other existing indicators, including catastrophic spending and impoverishing out-of-pocket spending, provide a general picture of the state of accessibility in EU Member States in relation to factors such as age, income or education, they do not necessarily reveal specific gaps in access or coverage that are linked to other characteristics or specific services. This workshop discusses a new method to measure access to health care, which was developed by the Observatory on Health Systems and Policies to support the European Commission's DG SANTE and the Expert Group on Health Performance Assessment (HSPA) in developing their work on more refined performance measures for health care system access across Europe. The work builds on the findings of a 2019 survey by the Observatory and its Health System and Policy Monitor (HSPM) network on “Gaps in Coverage and Access in the European Union”, which identified a range of vulnerable groups facing access hurdles. The overall goal is to provide a ‘proof of concept' to see whether a vignette approach could add to existing indicators, particularly regarding the differentiation between population coverage and realised access to care. A vignette is a short case study of an individual designed to simulate key features of a real-world scenario, which is then presented to relevant professionals to solicit their hypothetical response. Our workshop first discusses the vignette method developed for this purpose (presentation 1) before sharing the interpretation of results of two of the four vignette pilots that were carried out, that is, the vignette on stroke (presentation 2) and the vignette on palliative care for cancer patients (Presentation 3). The workshop will conclude with a moderated audience discussion about the pros and cons of the vignette method as opportunities to scale up the vignette approach. Key messages The vignette approach can identify gaps in coverage and access as well as differences in treatment and quality not identified by other indicators. The vignette approach can help explain how access contributed to suboptimal health outcomes, enabling the formulation of targeted policies.