Table 6 Induced barriers in healthcare access for elderly
Access to healthcare | Category | Effect on elderly |
|---|---|---|
Affordability | Current financial situation and pension cuts | â—‹ impoverishment of the elderly population â—‹ dependence on family |
Exemption allowances | â—‹ limited access for elderly with a middle income pension and especially with chronic conditions | |
Pharmaceuticals access | â—‹ restricted affordability of pharmaceuticals â—‹ patients with chronic diseases: poly-medication âž” interaction of medications âž” all required medication cannot be afforded | |
Primary care service utilization | â—‹ increase in co-payments âž” decrease in primary care visits | |
Specialist care service utilization | â—‹ Gate keeping system: patients need to pay both fees âž” chronically ill elderly as main users more disadvantaged | |
Approachability | Rearrangement of Primary care provision | â—‹ enhanced health provision for elderly through increased efficiency â—‹ still major deficiencies of a sufficient provision are reported: shortage of healthcare staff â—‹ difficulty to access for elderly with low mobility |
Hospital care service and emergency care | â—‹ greater efficiency in terms of diagnostic methods and quality of care provision â—‹ Higher pressure for healthcare staff âž” less time for patients â—‹ Hospitals not patient centred but disease centred built âž” access deficiently for elderly with co-morbidities | |
Health illiteracy | ○ barrier in the appropriate usage of the service for elderly ➔ lack of understanding on the usage of health care facilities and health benefits ➔ lack of engagement of elderly ➔ lack of understanding of the GP’s instructions on adequate application of pharmaceuticals | |
Integration of health sectors | â—‹ lack of follow up care â—‹ unnecessary stays of elderly in hospitals | |
Availability | Healthcare staff | â—‹ excessive emigration âž” less availability of health care staff â—‹ âž” lack of follow-up â—‹ âž” longer waiting times |
Long-term care | â—‹ shortage in follow-up and public long-term care (despite major improvements) | |
Health Transportation and walkability | â—‹ cuts on free of charge non-emergency patient transportations â—‹ alternative transport: âž” too costly âž” too difficult for elderly with low mobility âž” lack of adaptations (e.g. wheelchair fixture in busses) | |
Housing and isolation | â—‹ old houses mostly do not follow universal accessibility rules â—‹ âž” elevators installation missing âž” poor housing conditions: lack of heating âž” low mobility âž” fear of falling | |
Appropriateness | Waiting times | â—‹ increased waiting times for elective surgery (e.g. hip replacement surgery) |
Quality of care | â—‹ higher time constraints and pressure â—‹ âž” impairing quality of care: less patience | |
Policy response and elderly participation | â—‹ lack of specific policy response and priority setting at the local level â—‹ present health care plans: âž” still insufficient âž” rather unspecific âž” lacking the focus on access to health care services |