期刊论文详细信息
International Journal for Equity in Health
Barriers in access to healthcare services for chronic patients in times of austerity: an empirical approach in Greece
John Kyriopoulos1  Kostas Athanasakis1  Katerina Mylona1  Anastasis Skroumpelos1  Dimitris Zavras1  Ilias-Ioannis Kyriopoulos1 
[1] Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, Athens 11521, Greece
关键词: Greece;    Economic crisis;    Income decrease;    Unemployment;    Chronic patients;    Barriers in access;   
Others  :  1146527
DOI  :  10.1186/1475-9276-13-54
 received in 2014-01-23, accepted in 2014-04-18,  发布年份 2014
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【 摘 要 】

Objectives

To investigate the magnitude of barriers in access to health services for chronic patients and the socioeconomic and demographic characteristics that affect them.

Methods

A cross-sectional study was conducted in 1,594 chronic patients suffering from diabetes, hypertension, COPD and Alzheimer. Logistic regression analyses were carried out in order to explore the factors related to economic and geographical barriers in access, as well as the determinants of barriers due to waiting lists.

Results

A total of 25% of chronic patients face geographical barriers while 63.5% and 58.5% of them are in front of economic and waiting list barriers, respectively. Unemployed, low-income and low-educated are more likely to face economic barriers in access. Moreover, women, low-income patients, and patients with lower health status are more likely to be in front of geographical barriers. In addition, the probability of waiting lists occurrence is greater for unemployed, employees and low income patients.

Conclusions

Barriers in access can be mainly attributed to income decrease and unemployment. In this context, health policy measures are essential for removing barriers in access. Otherwise, inequalities may increase and chronic patients’ health status will be deteriorated. These consequences imply adverse effects on health expenditure.

【 授权许可】

   
2014 Kyriopoulos et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, Hudson M: What does ‘access to health care’ mean? J Health Serv Res Policy 2002, 7:186-188.
  • [2]Penchansky R, Thomas JW: The concept of access: definition and relationship to consumer satisfaction. Med Care 1981, 19:127-140.
  • [3]Vandoros S, Hessel P, Leone T, Avendano M: Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach. Eur J Public Health 2013, 23:727-731.
  • [4]Zavras D, Tsiantou V, Pavi E, Mylona K, Kyriopoulos J: Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece. Eur J Public Health 2013, 23:206-210.
  • [5]Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, Mackenbach JP, McKee M: Financial crisis, austerity, and health in Europe. Lancet 2013, 381:1323-1331.
  • [6]Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D: Health effects of financial crisis: omens of a Greek tragedy. Lancet 2011, 378:1457-1458.
  • [7]Cutler DM, Knaul F, Lozano R, Mendez O, Zurita B: Financial crisis, health outcomes and aging: Mexico in the 1980s and 1990s. J Public Econ 2002, 84:279-303.
  • [8]Anderson G, Horvath J: The growing burden of chronic disease in America. Public Health Rep 2004, 119:263-270.
  • [9]Jong-wook L: Global health improvement and WHO: shaping the future. Lancet 2003, 362:2083-2088.
  • [10]Whitehead M: The concept and principles of equity and health. Int J Health Serv 1992, 22:429-445.
  • [11]Minas M, Koukosias N, Zintzaras E, Kostikas K, Gourgoulianis KI: Prevalence of chronic diseases and morbidity in primary health care in central Greece: an epidemiological study. BMC Health Serv Res 2010, 28:252.
  • [12]Athanasakis K, Psychogios K, Kyriopoulos J: The economic and social extensions of Alzheimer. Neurologia 2009, 18:220-227.
  • [13]Athanasakis K, Ollandezos M, Angeli A, Gregoriou A, Geitona M, Kyriopoulos J: Estimating the direct cost of Type 2 diabetes in Greece: the effects of blood glucose regulation on patient cost. Diabetic Med 2010, 27:679-684.
  • [14]Geitona M, Hatzikou M, Steiropoulos P, Alexopoulos EC, Bouros D: The cost of COPD exacerbations: a university hospital-based study in Greece. Resp Med 2011, 105:402-409.
  • [15]Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M: Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 2006, 27:1610-1619.
  • [16]Souliotis K, Kyriopoulos J: The hidden economy and health expenditure in Greece: measurement problems and policy issues. Appl Health Econ Health Policy 2003, 2:129-134.
  • [17]Tountas Y, Karnaki P, Pavi E, Souliotis K: The ‘unexpected’ growth of the private health sector in Greece. Health Policy 2005, 74:167-180.
  • [18]Dalstra JAA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, Geurts JJM, Lahelma E, Van Oyen H, Rasmussen NK, Regidor E, Spadea T, Mackenbach JP: Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 2005, 34:316-326.
  • [19]Cutler DM, Lleras-Muney A: Education and Health: evaluating theories and evidence. [ http://www.nber.org/papers/w12352.pdf?new_window=1 webcite]
  • [20]Berkman LF: The role of social relations in health promotion. Psychosom Med 1995, 57:245-254.
  • [21]Kington RS, Smith JP: Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. Am J Public Health 1997, 87:805-810.
  • [22]Fiscella K, Williams DR: Health disparities based on socioeconomic inequities: implications for urban health care. Acad Med 2004, 79:1139-1147.
  • [23]Goddard M, Smith P: Equity of access to health care services: theory and evidence from the UK. Soc Sci Med 2001, 53:1149-1162.
  • [24]Beaglehole R, Ebrahim S, Reddy S, Voûte J, Leeder S: Prevention of chronic diseases: a call to action. Lancet 2007, 370:2152-2157.
  • [25]Yach D, Hawkes C, Linn Gould C, Hofman KJ: The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 2004, 291:2616-2622.
  • [26]World Health Organization: Innovative Care for Chronic Conditions: Building Blocks for Action. Geneva; 2002.
  • [27]Suhrcke M, Nugent RA, Stuckler D, Rocco L: Chronic Disease: An Economic Perspective. [ http://archive.oxha.org/initiatives/economics/knowledge/publications/oxha-chronic-disease-an-economic-perspective.pdf webcite]
  • [28]Arrow KJ: Uncertainty and the welfare economics of medical care. Am Econ Rev 1963, 53:941-973.
  • [29]Oxford Health Alliance Group: Economic consequences of chronic diseases and the economic rationale for public and private intervention. [ http://archive.oxha.org/meetings/knowledge/publications/05-meeting-documentation/economics_of_chronic_disease_26oct.pdf webcite]
  • [30]Geneau R, Stuckler D, Stachenko S, McKee M, Ebrahim S, Basu S, Chockalingham A, Mwatsama M, Jamal R, Alwan A, Beaglehole R: Raising the priority of preventing chronic diseases: a political process. Lancet 2010, 376:1689-1698.
  • [31]Wagner EH, Grothaus LC, Sandhu N, Galvin MS, McGregor M, Artz K, Coleman EA: Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care 2001, 24:695-700.
  • [32]Rothman AA, Wagner EH: Chronic illness management: what is the role of primary care? Ann Intern Med 2003, 138:256-261.
  • [33]Bodenheimer T, Lorig K, Holman H, Grumbach K: Patient self-management of chronic disease in primary care. JAMA 2002, 288:2469-2475.
  • [34]Holman H, Lorig K: Patients as partners in managing chronic disease. BMJ 2000, 320:526-527.
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