Health
Research insight
June 18, 2021

Access to Health Care – Citizens' Choices 2020 Report

The BPI | "la Caixa" Foundation Chair in Health Economics aims to promote research and discussions in the health care area. The Chair is part of the Social Equity Initiative, launched in 2019 by the "la Caixa" Foundation, BPI, and Nova SBE, and intends to create more value for our country's health care sector. It also aims to contribute to a better understanding of Portuguese society and its relation with the health care system and discuss health-focused policies. It will allow the continuation of analyzing new trends and challenges, either through independent impact assessments or analysis to enable a better response by the health system and its policymakers to the population's needs and expectations.

It was awarded to Pedro Pita Barros, Professor of Economics at Nova SBE and Coordinator of the Nova SBE Health Economics & Management Knowledge Center, as a recognition of the work carried out in the ​​Health Economics area and evidenced by his participation in the European Union's Expert Panel on Effective Ways of Investing in Health, as well the work carried in the Mission Board for Cancer,  the National Health Council, and the National Council of Ethics for the Life Sciences.

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Access to Health Care – Citizens' Choices

Why?

Portuguese society's values on access to health care services are underlined in the Portuguese Constitution and Lei de Bases da Saúde [Health Basic Law]. Little is known about citizens and their decisions on when and how they contact the health care system when they feel sick and before starting their journey within the national health system (in the public or private sector).

How?

Through a population survey with a representative sample of 1271 inhabitants in Portugal over 15. It was the chosen way to learn more about what goes on under the radar of the health system and is not on the National Health Service's record. The GfK company carried out data collection.

What did we learn?
  • There are socioeconomic inequalities when an illness occurs, but there is uniformity when accessing the health care system. Access conditions to the health care system do not enhance these inequalities. The decision to first contact the health care system displays very few obstacles regarding access. When accessing the health care system, impediments are not systematically associated with socioeconomic status within the collected sample (vulnerable populations not captured by these surveys indeed have specific problems). Difficulties occur in case of illness and are not related to health care conditions. From a citizen's perspective, access to the health care system improved, generally, from 2015 to 2020.

  • Self-medication is predominant in those who decide not to reach the health care system. Nevertheless, some citizens choose not to go to the health care system when feeling sick (about 10 %), regardless of their socioeconomic status. Of the sample, 63 % chooses to self-medicate. It is essential to learn how and the consequences that it entails.

  • There was no "escaping" from the National Health Service to the private sector, nor was the private sector abandoned. There was a reconfiguration within each. When choosing first to contact the health care system, the National Health Service is the leading choice of all socioeconomic groups. The private sector option is clustered in higher socioeconomic classes. Circa 7,3% of those who feel sick have this choice. This proportion rises to 15 % if someone has a higher socioeconomic status.

  • In 2020, the "escape" was from hospital emergencies, public and private, to another point of contact of the same industry. The number of people who mentioned a hospital emergency as their first contact with the health care system dropped from 41,1 % in 2019 to 32,2% in 2020 in the public sector and fell from 5 % to 2,1 % in the private sector.

  • The main financial difficulties in accessing health care services are associated with medical costs, even though there have been substantial improvements in recent years. The number of people who stopped buying the medical supplies they should, at least once a year, from 2017 to 2020, went from 10,7 % to 5,4 %. However, there are relevant socioeconomic inequalities. This amounted to 2 % in those two years for higher socioeconomic classes and rose from 11 % to 15 % for lower socioeconomic classes. Even though with lower numbers, a similar evolution emerged under the pretext of "not going to an appointment or doing a medical exam due to lack of money" (from 7 % in 2017 to 10 % in 2019 in lower socioeconomic classes).

  • For those who opt for the National Health Service when they have an unexpected illness, the main expense is the co-payment of prescribed drugs (average prices range from 21€ on prescriptions to 25€ total for a specific treatment, including user fees and transport, regarding primary health care services. When there is a hospital emergency, expenses amount to 24€ in prescriptions and 36€ total).

  • In 2020, there are two new "access obstacles" – the fear of reaching out to the health care system due to COVID-19, which was referred by 15 % of people, and having the health service provider cancel the appointment at his own initiative, referred to by 20 % of the people interviewed. Older people and people with lower socioeconomic status stated to have more fear. Cancellations under the provider's initiative affected all socioeconomic classes equally. The elderly, who usually have more medical appointments, were the ones who were more affected. Despite the fear, people still trust health care services (those who were more isolated during the pandemic are no longer afraid of going to the health care system).

  • Three out of four people feel they have been treated with dignity, compassion, and respect by the health care system's services. Even though there is a global number of 76,6%, in 2020, people who mentioned that they were treated with dignity, compassion, and respect, there were differences in said treatment associated with their level of education – 80% of people with basic levels of education to 72 % with higher education. Similar assessments in England show numbers ​​above 80 % and close to 90 % regarding specific health services.

What needs to get better?

  • Get to know the self-medication of those who do not seek the health system better
  • Improve the financial protection in medicine consumption
  • Improve the human aspect of the health care system's provision
  • Consolidate the primary health care response and its planned use

This information was originally published in Nova SBE Leadership for Impact Knowledge Center, here

Pedro Pita Barros

Pedro Pita Barros

Professor, Nova SBE

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