A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable.
Austerity
European Union
Healthcare access
Unmet medical need
Vulnerable populations
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
05 01 2023
05 01 2023
Historique:
received:
30
07
2022
accepted:
13
12
2022
entrez:
5
1
2023
pubmed:
6
1
2023
medline:
10
1
2023
Statut:
epublish
Résumé
There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013). This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included. The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status. Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.
Sections du résumé
BACKGROUND
There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return.
OBJECTIVE
This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013).
METHODS
This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included.
RESULTS
The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status.
CONCLUSION
Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.
Identifiants
pubmed: 36604705
doi: 10.1186/s12939-022-01806-1
pii: 10.1186/s12939-022-01806-1
pmc: PMC9815671
doi:
Types de publication
Systematic Review
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3Informations de copyright
© 2022. The Author(s).
Références
Eur J Public Health. 2017 Oct 1;27(suppl_4):18-21
pubmed: 29028245
Health Policy. 2015 Jan;119(1):100-6
pubmed: 25481024
Int J Health Serv. 2016;46(2):241-61
pubmed: 27076652
Curr Opin Anaesthesiol. 2013 Apr;26(2):186-92
pubmed: 23385323
Int J Med Sci. 2014 Mar 11;11(5):442-7
pubmed: 24688306
Eur J Health Econ. 2015 Sep;16(7):781-96
pubmed: 25186072
Int J Health Serv. 2019 Jan;49(1):108-126
pubmed: 30388375
Eur J Public Health. 2018 Jun 1;28(3):398-404
pubmed: 29452396
BMC Health Serv Res. 2016 Jul 27;16:309
pubmed: 27460938
Int J Equity Health. 2013 Mar 11;12:18
pubmed: 23496984
Int J Equity Health. 2021 Mar 16;20(1):79
pubmed: 33726753
Int J Environ Res Public Health. 2021 Jan 21;18(3):
pubmed: 33494518
Int J Equity Health. 2021 May 7;20(1):116
pubmed: 33962627
Health Policy. 2016 Jul;120(7):833-9
pubmed: 27263063
Int J Health Serv. 2006;36(4):651-77
pubmed: 17175840
Int J Epidemiol. 2004 Aug;33(4):650-67
pubmed: 15282219
BMJ Open. 2018 Oct 12;8(10):e022932
pubmed: 30317184
Int J Epidemiol. 2001 Aug;30(4):668-77
pubmed: 11511581
BMJ. 2013 Jun 13;346:f2363
pubmed: 23766463
Lancet Reg Health Eur. 2022 Oct;21:100508
pubmed: 36091079
Int J Equity Health. 2017 Nov 15;16(1):199
pubmed: 29141634
Health Policy. 2016 Nov;120(11):1293-1303
pubmed: 27743703
Lancet. 2013 Apr 13;381(9874):1323-31
pubmed: 23541059
Soc Sci Med. 2020 Dec;267:112496
pubmed: 31515082
Gac Sanit. 2021 Jan-Feb;35(1):42-47
pubmed: 32340750
Int J Health Serv. 2016;46(2):283-99
pubmed: 26825100
Int J Equity Health. 2017 Oct 25;16(1):184
pubmed: 29070050
Health Policy. 2018 Nov;122(11):1155-1160
pubmed: 30193979
BMC Public Health. 2019 Sep 2;19(1):1202
pubmed: 31477064
Rheumatol Int. 2014 Jan;34(1):25-33
pubmed: 24057144
J Health Soc Behav. 1995;Spec No:80-94
pubmed: 7560851
Scand J Public Health. 2017 Aug;45(18_suppl):48-55
pubmed: 28850012
BMC Public Health. 2021 Feb 19;21(1):385
pubmed: 33607960
Eur J Public Health. 2016 Apr;26(2):236-41
pubmed: 26538549
BMC Public Health. 2020 May 19;20(1):564
pubmed: 32423441
Int J Health Policy Manag. 2015 Sep 27;5(2):83-9
pubmed: 26927393
PLoS One. 2018 Mar 30;13(3):e0195293
pubmed: 29601609