Eurofound is an Agency of the EU, providing knowledge to assist in the development of better social, employment and work-related policies. It has published various reports in the past on issues related to health, such as a report on ‘access to healthcare in times of crisis’.
Eurofound also runs the European Quality of Life Survey (EQLS), which includes information on quality of -and access to- healthcare services. The overview report, where the general results of the latest data are presented, has just been published. Face-to-face interviews for the 4th wave of the EQLS were held in 2016, following earlier waves in 2011, 2007 and 2003.
Quality Ratings of the Healthcare System
Quality ratings of the healthcare system have improved on average, but not for all population groups.
People in the EU rate primary care services particularly high, but hospital services score high as well. Only Finland and Sweden have higher ratings for hospital services. This connects to an initiative in Malmo earlier identified by Eurofound to locate a primary care in the hospital to steer people towards this cheaper form of healthcare.
Overall, quality ratings for healthcare services have increased since the previous waves.
For the first time in 2016, the EQLS it asks specifically about hospital and primary care, not only overall quality ratings, but also looking into different aspects of quality and perceived equal treatment in these services. Both hospital and primary care get high ratings. However, ratings for primary care are highest, and about two-third of people had used such services in 2016. ‘Being informed and consulted about care’ appears to be one of the elements where there is most room for improvement in the EU. Both for hospital and primary care services, users tend to be particularly satisfied with ‘professionalism of staff’.
There are country differences in self-reported quality of healthcare services. A more detailed forthcoming report by Eurofound on services reveals that several countries score either relatively well on all four subjective quality dimensions of primary care (Austria, Luxembourg, Ireland, Germany), or relatively badly on all of them (Portugal, Bulgaria, Greece, Italy). However, even within these countries there are some differences between the dimensions. In particular, while Ireland scores are in the top 3 on all other three dimensions, it does a bit worse for quality of the facilities. Similarly, while Portugal is in the bottom 2 for all other three dimensions, it scores a bit better for quality of the facilities.
For other countries there is more diversity among these four dimensions of quality of primary care services. In particular, Denmark is among the top 3 for all other three dimensions, but comes 20th of all 28 Member States about ‘being informed or consulted about care’. In the UK and Sweden, quality of the facilities comes-out much better than any of the other three dimensions, while in Croatia and Malta the reverse is true, with quality of the facilities ranking relatively low.
Access to Primary Care
Access to primary care can be difficult mainly due to waiting times, but cost also forms a barrier to population groups in many Member States. In the EU, waiting time at the healthcare venue (38%) and waiting lists to get an appointment (42%) are the most common factors to make it difficult to access primary care. Cost is the least likely of all five factors to make it difficult to access primary healthcare (16%: 4% very difficult and 13% difficult), but countries show the largest variation with regard to the role of cost. Cost as a factor which makes access difficult ranges from 3% of the population in Denmark (and 5% in Spain and UK) to 62% of the population in Greece and Cyprus (and 51% in Malta).
Some countries are worth highlighting, because they score particularly well on one factor but particularly badly on another. This confirms the importance of exploring multiple dimensions of access. Examples include the UK where cost is rarely a problem for access to primary care, but delays in getting an appointment more often than in any other Member State. A similar, but less pronounced, observation holds for Denmark, Sweden, Germany, Slovenia and Hungary. Other countries show the contrary pattern. In Ireland cost particularly often makes it difficult to access primary care, but on average getting an appointment is much less of a problem. A similar, but less pronounced trend can be found in: Cyprus, Luxembourg, Bulgaria, Slovakia, Belgium, Italy.
With regard to cost as a barrier in accessing services, the EQLS 2016 asked how easy or difficult it would be for respondents to cover the expenses for several specific healthcare services if they needed them tomorrow. Results from the overview report show that feelings of being covered for future healthcare service need vary across the type of services. In the EU28 as a whole, people most often reported that it would be ‘very difficult’ or ‘difficult’ to cover expenses for dental care (36%) and for ‘psychologist, psychiatrist or other mental health services’ (34%). Primary care service expenses (GP, family doctor or health centre services) were seen as the least difficult to cover (17%). Emergency healthcare (23%) and ‘other hospital or medical specialist services’ (29%) lie in between.
Fairness in Treatment and Corruption
The EQLS 2016 contained two questions to elicit perceptions regarding fairness in treatment and corruption. On average, agreement that corruption is present in the respondents’ area is higher for hospital services (3.2) than for GP services (2.9). It is higher among people in urban than in rural areas for both hospital services (3.3 compared with 3.0) and GP services (3.0 compared with 2.7).
Many have also delayed or not gone to the doctor, even if this is more often the case for dental care. Only in a few countries e-health for prescriptions or consultation are common. While telemedicine has the potential to improve access to healthcare, particularly in remote areas, online/telephone consultations are actually more common in urban than rural areas.
- EQLS 2016: https://www.eurofound.europa.eu/surveys/european-quality-of-life-surveys/european-quality-of-life-survey-2016
- Overview report: http://bit.ly/EQLS-overview
- Selected graphs: http://bit.ly/EQLS-interactive
- Main results on the Survey Mapping Tool: http://bit.ly/EQLS-SMT
- EQLS source questionnaire: http://bit.ly/EQLS-Q
- More information about the EQLS: http://bit.ly/EQLS-info
- Overview report: http://bit.ly/EQLS-overview