Health Care In European Countries Research Articles

Determinants of access to healthcare in European countries

Determinants of access to healthcare in European countries

The experience of racism against migrants in healthcare in Europe: a scoping review

Abstract Background Racial discrimination is frequently mentioned as a social determinant of migrants’ health. However, in the European context, racial discrimination and its impact on migrants’ access to healthcare is under-researched. This scoping review makes a first step toward filling this void by mapping the literature on racism against migrants in healthcare in Europe and identifying evidence gaps. Methods Following PRISMA guidelines, four databases were searched for empirical, peer-reviewed studies on manifestations, experiences, or impacts of racism against migrants in healthcare settings in European countries, published in English between 1992 and 2022. Out of 2365 articles screened, 43 were included in the data extraction. A quality assessment and narrative synthesis were performed. Results Our synthesis of the extant evidence identifies three interrelated ways in which racism manifests in and impacts migrants’ healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. However, our analysis demonstrates that for many country and healthcare contexts, research on racism in healthcare is lacking. Most studies apply an explorative qualitative research design, while the comparability and generalizability of research results are low. Furthermore, there is a near-exclusive research focus on racism at the interpersonal level, with little data on institutional and structural levels. Conclusions The review pinpoints limitations and lacunae in the current body of knowledge; namely a lack of evidence for many country and healthcare contexts, a dearth of generalizable results, and a near-exclusive focus on racism on the interpersonal level as compared to structural levels. At the same time, its findings underscore how racism reinforces inequities in healthcare and health outcomes. It thus highlights the need for systematic research on racism in healthcare in Europe. Key messages • Racism against migrants in healthcare reinforces health inequities through anti-migration bias, health(care)-related prejudice, and differential medical treatment. • Research on racism in healthcare in European countries is scarce; especially systematic and generalizable evidence and evidence on racism on structural levels is lacking.

Assessing the contribution of migration related policies to equity in access to healthcare in European countries. A multilevel analysis

Access to good healthcare and the conditions for good health is one of the central dimensions of immigrant integration. National health policies play a major role in equipping residents with the necessary entitlements to accessible and acceptable healthcare services. Rarely analysed so far is the contribution of migration-related health policies to equity in access to healthcare between immigrants and the general population. To address this gap, this study analysed whether the extent to which migration is considered within national health policies moderates the association between immigration status and subjectively perceived unmet medical need in Europe. Using data from the 2019 European Union Statistics on Income and Living Conditions (EU-SILC) survey in combination with the Migration Integration Policy Index (MIPEX) a multilevel analysis was carried out assessing the cross-level interaction between immigration status and MIPEX scores controlling for individual-level factors such as age, gender, education and employment status. While our results showed that immigrants are more likely to report unmet medical need than the general population (adjusted Odds Ratio (aOR) = 1.32; 95% confidence interval (CI) 1.22–1.43), the cross-level interaction indicated increased relative inequality in unmet medical need between immigrants and the general population in countries with high MIPEX scores compared to countries with low MIPEX scores (aOR = 1.39, 95% CI: 1.18–1.63). The main reason for this increase of inequality on the relative scale was the overall lower prevalence of unmet medical need in countries with high MIPEX scores. In conclusion, our findings indicate that even in countries with relatively migration-friendly health policies inequalities in access to healthcare between immigrants and the general population persist.

Cultural competence among nursing students and nurses working in acute care settings: a cross-sectional study

BackgroundThe increasing cultural diversity in healthcare in European countries, including Austria, has highlighted the need to enhance nurses’ cultural competence. Assessing cultural competence and identifying relevant influencing factors can help to improve culturally competent care. The aim of this study was to assess the cultural competence of nurses and nursing students working in Austrian acute care settings and to identify influencing factors using the Cultural Competence Assessment scale.MethodsA cross-sectional design was used. Data collection was carried out in March 2021 with nurses and nursing students in the last year of their studies who were working in Austrian acute care settings. Descriptive analysis was applied to display the general characteristics of the study participants and the levels of their overall cultural competence. A multiple linear regression analysis was conducted to analyze the influencing factors of cultural competence.ResultsThe nurses’ cultural competence level was moderate to high (mean = 3.89; SD = .48). Their age, educational level, cultural diversity training and self-perceived cultural competence significantly influenced the level (F (6, 875) = 18.971, p < .0000, adj. R2 = 1.09).ConclusionsProviding culturally competent healthcare services for culturally diverse patients is essential for all healthcare professionals, and especially for nurses who spend the most time with patients. Effective interventions, such as educational training, need to be implemented in order to deliver culturally competent care and potentially reduce disparities in healthcare and improve patient outcomes.

5.N. Workshop: Children first: do health systems pay enough attention to their youngest constituents?

Abstract This workshop aims to bring together a range of insights on how health systems have dealt with child health and health care, highlighting both successes and challenges. For children, access to health care is vital. It impacts their physical and emotional health and wellbeing and largely determines whether they can reach their full potential as adults, which is also important to their families and society at large. Consequently, it comes as no surprise that he 1989 UN Convention on the Rights of the Child, which was ratified by all European countries, guarantees a fundamental right to healthcare for all children. However, various national governments do not fully comply with the Convention, and evidence exists that children may not always enjoy the necessary access to meet their needs. In 2021, Doctors of the World (DoW) concluded that there are urgent questions about the welfare and health of vulnerable children across Europe, based on the increase in children seeking healthcare from DoW clinics instead of the national health system. This concerning trend is not captured well enough in available statistics. What is more, the COVID-19 pandemic and the Ukrainian refugee crisis raise additional concerns as to how health systems will deal with the observed increases in related paediatric sequelae and mental health needs. The aims of this workshop are therefore to stimulate discussion around better understanding children's access to health care and how it relates to health system performance, and provide impetus for new initiatives that can improve health care for children. The workshop will take a hybrid format, kicking off with three short presentations followed by a round table discussion and engagement with the audience. The presentations will cover the regulatory framework for children's access to health care in European countries; identified bottlenecks of health system performance specific to child services from a range of countries around the world; and the impact of COVID-19 on hospital care for children based on the example of one European country. Key messages • Ensuring children’s access to health care is now more important than ever; a lot more can and should be done at all levels. • More and better data about children’s health and health care access is necessary to enable effective policies; collecting it should become a health system priority.

Health Care for Refugees in Europe: A Scoping Review.

Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.

Evaluation of Selected Indicators of Health Care in the Context of Health care Systems: Case of 27 European Union Countries

Healthcare in European countries is provided through different systems run at national levels. The aim of the article is to evaluate selected health care indicators in EU countries, while accentuating similarities and differences between the EU countries in the context of health care systems. Applying the method of multivariate analysis, the selected health care indicators (from the areas of financing, service provision, health status) are evaluated on a set of 27 EU countries in the period 2013-2018. Factor analysis was applied to generate two factors (i.e. expenditures and satisfaction with health care, health status and bed availability in hospitals) from the original indicators of health care. As a next step, hierarchical cluster analysis was utilised to divide the EU countries into six clusters by similarity of the health care factors. The results of the factor analysis demonstrate marked differences between the countries regarding the evaluated health care factors. A higher (lower) level of socio-economic development is the aspect of better (worse) results of health care in the majority of the countries evaluated. However, according to the evaluated health care factors, clusters of similar countries used different systems of health care by type and source of financing. The findings thus demonstrate both similar and different approaches towards the provision of health care and funding health care systems in EU countries.

Quality of child healthcare in European countries: common measures across international databases and national agencies.

BackgroundThe evaluation of child healthcare is not yet widely explored, especially from a cross-country comparison perspective. The routine adoption of measures by national assessment agencies is under-investigated. Though the guiding principles developed at international level call for a child-centric multi-dimensional evaluation of child care, its feasibility is hampered by the availability of robust and harmonized data.MethodsTo explore the data availability, international databases (IDBs) were scrutinized and measures dealing with child health-related issues were collated. In parallel, an ad hoc questionnaire was administrated to 30 Country Agents (CAs) to gather measures routinely adopted at local level. To facilitate the comparison of measures, a three-level conceptual map was developed.ResultsThe IDBs yielded at 207 measures that pertained mainly to non-health determinants of health, whereas the 352 measures obtained from CAs focused on process and outcome. A set of 33 common measures that related to immunization, morbidity and mortality were identified.ConclusionsA limited set of measures used both in IDBs and at national level identify common areas of concerns that certainly capture crucial issues with child prevention and health outcomes. However, they are far from satisfying a child-centric multi-dimensional approach to the evaluation of child well-being and well-becoming. There is room for improvement at both international and national levels. IDBs should include and harmonize measures that concern the provision of child-centric services and encompass physical, social and mental development. At the national level, efforts towards the inclusion of measures that concern non-health determinants of health should be pursued.

INVESTMENTS IN MEDICINE IN THE RUSSIAN MODEL OF HEALTHCARE FINANCING: PROBLEMS AND SOLUTIONS

The article deals with the issues of financing of domestic health care. In the context of historical development, the way of formation and development of public health in Russia is shown. Based on statistical data, it is established that the situation with the financing of health care does not meet all its needs, and the annual cost of medicine per person is twice less than in the least developed European countries. A comparative analysis of the ways of financing health care in European countries is carried out, as a result of which the positive and negative aspects are highlighted in the budget model of health care, inherent in England and Sweden, and the insurance model used in most other European countries. Separately, the features of financing Russian medicine, which is expressed in the multi-channel budget-insurance model, are considered. The disadvantages of this type of financing are noted. Data on the lack of investments in healthcare, as well as the reasons for this, are presented. Investment risks in the healthcare sector are highlighted. Materials and methods. The study is based on the analysis of the current legislation in the field under consideration and scientific publications containing different points of view on the problem under study. General scientific methods of analysis and synthesis were used, as well as such special disciplinary methods as formal-legal, comparative-legal and historical. Conclusions. The most important task facing the industry is to increase investment activity, which can only be solved by creating favorable conditions for private investors, since taking into account the systematic economic crises and political pressure, public funds for medicine are clearly not enough. But it is necessary to solve the issues of creating favorable conditions for attracting investment in the healthcare sector by changing the system of financing domestic medicine.

Healthcare data warehouse system supporting cross-border interoperability.

The free movement of European citizens across member states of the European Union adds an important level of complexity to strategic efforts of health interoperability. The use of electronic health data has been marked as an important strategic activity and policy to improve healthcare in European countries. Cross-border healthcare depends on the ability to set up shared practices with respect to patient data exchange across the countries. Data flow must comply with demanding security, legal and interoperability requirements, as defined by the European Patients Smart Open Services project specifications. The aim of this article is to propose a novel design of healthcare data warehouse based on the restructured Extract-Transform-Load process. We describe a portal framework that offers a comprehensive set of interoperability services to enable national e-Health platforms to set up cross-border health information networks compliant with European Patients Smart Open Services. The presented approach incorporates the technical and organizational interoperability by interconnecting Health Level Seven standard and Open National Contact Points framework in order to provide a modular, scalable and inter-operating architecture.

The EPA Guidance Project: Guidance for Mental Healthcare in Europe

Summary Background: The development of guidelines is an important and common method to assure and improve quality in mental healthcare in European countries. While guidelines have to fulfill predefined criteria such as methodological accuracy of evidence retrieval and assessment, and stakeholder involvement, the development of guidance was not standardized yet. Aim: In 2008, the European Psychiatric Association (EPA) initiated the EPA Guidance project in order to provide guidance in the field of European psychiatry and related fields for topics that are not dealt with by guideline developers – for instance due to lack of evidence or lack of funding. The first three series of EPA Guidance deal with diverse topics that are relevant to European mental healthcare, such as quality assurance for mental health services, post-graduate training in mental healthcare, trust in mental health services and mental health promotion. Results: EPA Guidance recommendations address current and future challenges for European psychiatry. They are developed in accordance with the World Health Organization (WHO) European Mental Health Action Plan.

IS-007 European Paediatric Association

<h3>Avoiding Unnecessary Variations and Diversities of Child Health Care Systems in Europe</h3> Paediatrics in Europe is characterised by the diversity, variety and heterogeneity of health care offered in the 53 European countries with more than 200 million children aged less than 18 years and with more than 200.000 paediatricians. Paediatrics respects the rules on child development which state that an adolescent is not a young adult, a school child is not a small adolescent, an infant is not a small child, a neonate is not a small infant and a premature newborn is not a small neonate. Paediatricians care for both healthy and sick children. Health care management differs according to where it is offered such as inpatient care in hospitals, outpatient care in hospitals or in private practices, homecare and rehabilitative care in special rehabilitation units. Paediatric health care focuses on the patient and not on diseases; however children with acute diseases need a completely different case management than children with chronic diseases. Special care is given to underprivileged and marginalised children such as children with chronic diseases and disabilities, children with a migrant background and poor children. Children have no voice in society and their caregivers do not speak with one voice, which has led to considerable inequity of health care in many European countries. There is currently no European wide “bank” of data to enable comparative studies of service outcomes to encourage health service research relating to infants, children and young people. The aim of our presentation is to improve international cooperation in child health care in all European countries in order to improve future services. Understanding how and why services work, relating structure and process to experience and outcomes is essential at a time of economic recession. Paediatricians should not aim at creating a monopoly; instead they must favour the team approach of all caregivers.

諸外国におけるプライマリ (ヘルス) ケア卒前教育の現状ヨーロッパ諸国

諸外国におけるプライマリ (ヘルス) ケア卒前教育の現状ヨーロッパ諸国