The accessibility of healthcare for poor people in Slovenia

Danica Rotar Pavlic, MD, PhD, Jantien Altena, medical student

Pisa, 2010

Contents

IntroductionMethodsResultsDiscussionConclusion

Introduction

Health inequalities between socioeconomic classes

Health outcomes Self-reported health Specific conditions Mortality

Utilization Primary care practioner Secondary care Hospital admissions

Introduction-Methods-Results-Discussion-Conclusion

Introduction

Healthrisk Unhealthy behaviour Material circumstances Childhood circumstances Psychosocial factors

Barriers patient’s side Patient’s attitude Lack of knowledge

health literacy Lack of skills: coping,

decision making and concordance

Barriers provider’s side Characteristics of

healthcare system Personal attributes of

healthcare provider

Lack of money

Introduction-Methods-Results-Discussion-Conclusion

Introduction

In 1971 the death rate for adult men in social class V (unskilled workers) was nearly twice that of adult men in social class I (professional workers).

People from low socio-economic classes experience barriers in healthcare after they develop an illness.

Problems originate in some adverse psychosocial factors: the patient’s attitude toward illness and towards the healthcare system and insufficient coping styles .

This is closely linked to a lack of knowledge and health literacy which is more common among the poor and can lead to problems with the awareness of their own health condition, treatment options, diagnostic possibilities and recurrence.

To explore the accessibility of healthcare for poor people.

The results can act as an guide for further studies about this subject needed for reformations in the primary healthcare

Aim of the study

Introduction-Methods-Results-Discussion-Conclusion

Methods: subjects and settings

Ljubljana fieldworkQualitative method (the complex details about

feelings, thoughts and social interactions)Ten participants selected by the district nurse

and the GPCriteria:

Income below poverty line Health problems

Introduction-Methods-Results-Discussion-Conclusion

Methods: interviews

Semi-structuredDeveloped by literature review about health

and income inequalities in the worldTen questions GP conducted the interviews at participant’s

homeTape-recorderd, transcribed and translated to

EnglishObservation by the researcher

Introduction-Methods-Results-Discussion-Conclusion

Methods: analysis

Grounded theory from Glaser and StraussIndepently coded by two researchersValidity controlAfter third coding agreement was reached

Introduction-Methods-Results-Discussion-Conclusion

Results

Citizins of Ljubljana or near LjubljanaCaucasianAverage age: 66,5 year (55-92)6 males and 4 femalesUnemployed

Introduction-Methods-Results-Discussion-Conclusion

Results

Multimorbidity

Mental State Stress Being captured Family history Loneliness (lack of social support)

“I often feel so lonely. I have no one who would talk to me or help me when I feel the most down.” (male, interview 9)

Introduction-Methods-Results-Discussion-Conclusion

Results: accessibility problems

Transportation: Low mobility No car No driving license or driver Difficulties to get on the bus Poor access from and to home Fear of walking Not an appropiate way

“ I do not have enough money to buy a car adjusted to my needs.” (female, interview 1)

“ I cannot walk there, not with my feet.” (female, interview 6)

Introduction-Methods-Results-Discussion-Conclusion

Results: accessibility problems

Dependence Other people:

Transportation Medical supplies Help with contact

Material: Mean of transport Portable oxygen bottle Crutches, wheelchair

Insurance coverage

“The neighbours would help me call” (male, interview 3)

Introduction-Methods-Results-Discussion-Conclusion

Barriers on patient’s side

  

Lack of knowledge Low education

Attitude towards healthcare

Dissatisfaction GP

Secondary care

Health visitor

Health systemAtmosphere health centre

Barriers on patient’s side Clinic for the homeless

Emotions associated with healthcare

Fear of doctors

Shame

Stubborn

Reminder of bad times

Dislike

Caring for family members Bedridden husband

Barriers on the providers side

  Availability GP Absent at practice

Long waiting time

Low frequency of home visits

Barriers on the provider’s side Problems to reach GP on the phone

Little time, busy

Absence of personal GP

Specialist Absence

Ambulance Waiting time

Attitude Not taking patients serious

Results: solutions

Self-managementAnother form of contactAnother mean of transport: ambulanceAnother type of medical servicePlanningHelp from others

Introduction-Methods-Results-Discussion-Conclusion

Results: consequences

Lower use of healthcareDistrict nurse most important person in primary

careDelay: late stage of disease

“The district nurse comes to see me every Thursday to control my blood sugar and pressure and to bring prescriptions and referral forms, if necessary. She is very kind to me and always asks me if I need anything else from the doctor.” (Male, interview 3)

Introduction-Methods-Results-Discussion-Conclusion

Discussion

Marital status, household composition and social support

Multiple barriersUse of emergency serviceInsufficient engagement of GPFurther researchLimitations

Introduction-Methods-Results-Discussion-Conclusion

Conclusion

Problems Barriers on patient’s side

Tranportation

Dependence

Barriers on provider’s side

Solutions Self-management

Other form of contact

Accessibility Other way of transport

Other medical service

Planning

Help from others

Consequences Low utilization

Important role of healthvisitor/district nurse

DelayIntroduction-Methods-Results-Discussion-Conclusion

Questions?