Abstract
BackgroundThe 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.MethodsThe 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).ResultsHealthcare 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.ConclusionsThe 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.
Highlights
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 fifth framework area, ́acceptability, was not identified in this study, due to the fact thatacceptabilityincorporates the aspects of professional values, norms, culture, and gender and assesses the perception of needs and desire for care of the care receiver
The authors decided to exclude this area, since gender or ethnic specific purposes, as well as cultural norms or values could not be identified in the answers of the interviewees and were not taken into account for this study
Summary
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. In May 2011, a three-year Bailout Programme, the Economic Adjustment Programme for Portugal, was introduced imposing austerity measures and budget cuts in three Memoranda of Understanding between the troika and the Portuguese Government: i) Memorandum of Economic and Financial Policies (MEFP), ii) Technical Memorandum of Understanding (TMU), iii) Memorandum of Understanding on Specific Economic Policy Conditionality (MoU) [26]. The continuous rise in public healthcare expenditure over the last decades as a percentage of the total government budget (13.8% in 2011) has added to the progression of the debt in the sector and is being predicted to be the highest in the European Union (EU) by 2060 [13]. Healthcare reforms and austerity measures were directed towards four main areas: pharmaceuticals, primary health services, hospital services and co-payments [13] [Table 2]
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