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124 Economic crisis, health systems and health in Europe: country experience
The imposition of public health spending restrictions (to no more than 6%
of GDP) and the simultaneous decline in GDP (since 2009, with further
decreases in the years that followed) means that the public health sector is
called upon to meet the increasing needs of the population with decreasing
financial resources. This has negative effects, particularly for the middle and the
low income households that do not have the disposable income to buy private
health services. Moreover, rising unemployment, part-time working, flexible
employment and austerity measures (e.g. public sector salary cuts) have led
to falls in household income and social health insurance funds' revenues. This
situation has led to additional strains on the already overloaded public health
system. Combined, these factors could lead to a de facto two-tier health system
where those who can afford to pay for private health services will be able to
meet their health needs, while those without sufficient resources must attempt
to access services from a severely strained public system.
Other burdens on the population, particularly the poorer strata of society,
include the increase in user charges, particularly for outpatient health care;
private physician consultations in the afternoon surgeries of public hospitals
on a FFS basis; patient fees for admission to public hospitals; increases in copayments
for medicines; and the removal of certain laboratory and other tests
from EOPYY reimbursement.
4.2 Access to services
Access to care, an essential element in achieving quality of life and growth, is
a main objective in the Europe 2020 strategic plan (European Commission,
2014). In times of crisis, reduced resources have a negative impact on access
to health care services mainly through increased demand, increased waiting
times and increased co-payments, but even through decreased ability to make
informal payments (Morgan & Astolfi, 2013).
Although there are no official data, anecdotal evidence from health care personnel
suggest that waiting times to receive public health services have increased. In
addition, according to data published by a market research company (which,
however, are limited in scope, with small samples and, in some cases, unknown
methods), 19% of survey respondents reported major problems in accessing
public hospitals because of waiting list issues and 28% of the sample stated that
they could not buy their medicines because of continuing pharmacists' strikes
during 2011 (Tripsa et al., 2012).
In terms of actual utilization rates, the results are mixed. First, it appears that
the use of public services, as opposed to private ones, has risen. For example,
a 24% increase in patient admissions to public hospitals (with an average
length of stay of 4.25 days) was recorded in 2010 compared with 2009, and