Tuesday, October 11, 2011

[EQ] Addressing inequities in access to health care for vulnerable groups in countries of the European region

Addressing inequities in access to health care for vulnerable groups in countries of the European region

Xenia Scheil-Adlung, Health Policy Coordinator, ILO, Social Security Department

Catharina Kuhl, ILO Consultant
GESS Global Extension of Social Security - International Labor Organization ILO, 2011

Available online PDF file [39p.] at: http://bit.ly/n9MfnI


“……Europe as a whole is often perceived as a group of wealthy countries where inclusive social protection systems provide comprehensive protection for the most vulnerable and health care at highest standards is easily accessible for everybody. Thus, persisting gaps in social health protection coverage and inequities in access to health services experienced by vulnerable groups receive only little attention and are rarely adequately analysed with regard to specific aspects such as gender, migration, or issues related to ethnic groups.

As a result, in times of financial constraints, policy discussions often turn around to cut back social protection expenditures without sufficiently investigating the impacts on those in need. The austerity programmes of the EURO debt crisis may serve as one of the most recent illustrations of such policies within the European Union. A further example of inadequate attention to inequities in access to health care is the negligible amount of donor aid for health in Europe, which at merely 0.34 US$ per capita is almost inexistent for many CEE/CIS countries2, despite documented challenges of achieving the Millennium Development Goals (MDGs) by 2015 in many countries of the broader European region.3

Against this background, this paper highlights issues that contribute to persisting inequalities in access to health care of vulnerable groups in the broader European region, including countries of the European Union (EU), the Commonwealth of Independent States (CIS), Central and Eastern Europe (CEE), and selected countries of Central Asia.


We focus on key determinants of vulnerability, primarily labour market impacts such as income, employment, and related gaps in access to social protection, and to social health protection in particular. Moreover, we concentrate on stratification of vulnerability looking at specific population groups, including women, the elderly, migrants, and ethnic groups, mainly Roma, who are often disadvantaged in regard with determinants of vulnerability as focused on here (Figure 1). Special attention is also given to rural and urban inequities.

First, we present the main characteristics of social health protection systems in countries of the European region regarding financing, organization, and benefit arrangements. We then analyze remaining gaps in social health protection in terms of legal coverage, financial protection and geographic availability of health services, and the impact on effective access for vulnerable groups…..”



1. Introduction

2. Main characteristics of social health protection systems in the European region

3. Determinants of inequities in access to health care due to gaps in social health protection

3.1. Gaps in legal coverage

3.2. Limitations in the scope of benefits

3.3. Gaps in financial protection

3.4. Geographical inequalities in access

4. Determinants of inequities in access to health care due to the socio-economic environment

4.1. Economic context and progress towards the MDGs in poverty, gender equality and health

4.2. Employment and the labour market structure

4.2.1. Female labour participation

4.2.2. Labour market structure

4.3. Income disparities

4.4. Poverty

4.5. The broader social protection system

5. Addressing inequities in access to health care for vulnerable groups

5.1. Extending coverage and effective access in social health protection

5.2. Addressing wider socio-economic inequalities with the social protection floor approach

6. Conclusions


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