Since the economic crisis, policy changes across Europe appear to be moving away from universal health systems with broad coverage to systems where sections of the population are excluded from the scope of publicly available services. A new EPHA report presents and analyses these trends from across Europe and makes a contrast between the evidence that inclusive health, social, welfare and employment policies being beneficial to the economy with recent changes and health outcomes.
As well as from making the economic case for universal access, the report makes a number of recommendations for policymakers at national and European level. This includes guarantees for fair and universal access for all, including the long-term unemployed, minorities such as Roma communities, refugees, and homeless people.
The literature demonstrates that there is ample evidence that universal, comprehensive welfare regimes deliver better health outcomes at population level. The effects of austerity policies in Europe have been harsh, particularly in Southern European countries, and many studies been undertaken comparing alternative policy options. They show that social inequalities in sickness are lower in countries that have invested in more comprehensive social policies. For example, active labour market programmes coupled with comprehensive benefits packages appear to produce lower levels of sickness and to reduce health inequalities. Labour market interventions in particular have protective effects on the mental health of unemployed people.
Yet, healthcare policy responses to the economic crisis have seemingly neglected these associations. Many governments opted to reduce coverage, for example by introducing new eligibility criteria, changes to the benefit basket, increases in co-payments, or to reduce the supply of services by cutting the number of facilities, hospital beds or personnel.
The evidence suggests that many policy measures adopted to reduce healthcare and pharmaceuticals costs during the economic crisis have compromised health systems’ stated goals of equity. As total public health expenditure in health has decreased steadily since the onset of the crisis, out of pocket expenditure to patients has increased. Concerns about deteriorating health access and the creation of new vulnerable groups are well-founded. Greece is the starkest example of a dramatically weakened health system where exclusion of up to a third of the population from health coverage is dramatically worsening public health. EPHA’s annual conference heard for example, that the majority of people seeking medical attention at some Medecins du Monde polyclinics in Greece are Greek citizens who have lost their health coverage due to their personal financial circumstances.
The report calls for governments to reverse the trend of means-testing health and social benefits and ensure health services are free at the point of delivery. It also calls on the European Commission to prioritise universal and fair access to healthcare and disease prevention, in line with the Sustainable Development Goals, in the European Semester process of economic recommendations to national governments and to asses impacts of fiscal and economic recommendations on health.
With an eye on the emergency situation in Greece but across Europe, EPHA calls for EU solidarity funds to be released to ensure basic primary care is available to all, including refugees, and that obstacles to access are removed.