Management in Health, Vol 15, No 3 (2011)

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ACCESS AND QUALITY OF HEALTH CARE SYSTEM BY OPINION OF PATIENTS IN TEN EUROPEAN COUNTRIES

ACCESS AND QUALITY OF HEALTH CARE SYSTEM BY OPINION OF PATIENTS IN TEN EUROPEAN COUNTRIES

 

Danguolė JANKAUSKIENĖ Ieva JANKAUSKAITĖ

 

Mykolas Romeris University Vilnius, Lithuania,

Lithuanian National Health Insurance Fund, Vilnius, Lithuania

 

 

ABSTRACT: The aim of the study is to evaluate the access and quality of health care systems by the opinion of the patients in 10 European countries.

Methods. Systematic review and comparative analysis of the data from the European surveys, published since 2007 till 2010 were used in order to compare the indicators of patient's satisfaction with the access and quality of health care system in 10 EU countries: Austria, Germany, Denmark, Sweden, Estonia, Latvia, Lithuania, Romania, UK and Slovenia. The systematic review inclusion criteria were: systematic review has to be performed in the latest available year, but not earlier than 2007, representative sample of the public opinion survey; the study had to be performed on an international scale (i.e. in all comparative countries), target groups of the study had to be the all users of health care services. Two groups of indicators were assessed: access and quality by the variables examined in the selected studies. Overall evaluation was made by the value for money adjusted evaluation score using scatter diagram in the SPSS statistical package program.

Facts and findings. The majority of the respondents in Austria and Sweden rate their healthcare system as good, but only a quarter of respondents in Romania and less than a half in Lithuania consider the quality of healthcare in their country as good or very good. It could be possible, that the financial and economic crisis has influenced those results. The access to health care is best evaluated by patients in Austria and Germany, the worst - in Latvia, Romania, Lithuania and Estonia. Sweden provides the worst access to family doctors, Estonia - to the hospitals among the all evaluated countries.

Conclusion. The overall assessment of quality and access in ten selected European countries considering value for money-adjusted evaluation shows that the leading countries in terms of health care quality are Austria, Denmark and Germany, whereas the worst quality is evaluated in Latvia, Romania, Lithuania and Estonia. In terms of health care access the leading three countries are still the same - Germany Austria and Denmark, while Lithuania, Latvia and Romania are estimated as most lagging behind.

 

Key words: health indicators, health care access, health care quality

 

 

INTRODUCTION

The access and quality improvement of health care services are the goals of every reform of health care system and medical aid in every country. Patient's opinion about their experiences in using health care services becomes an important tool for health care service quality and access improvement and monitoring. According to OECD (Economic Cooperation and Development Organization) and WHO (World Health Organization) outlines, studies on patient satisfaction for health care service quality and access are very important part of the overall evaluation of health care system and the basis for the forming of national health care policy [1,2].

In addition, total and constant quality management in the institutional level of health care services should also be based on credible information about patient expectations and satisfaction of using health care services [3].

Recently, there have been a lot of patient satisfaction surveys and studies made worldwide. Some countries execute constant systematic monitoring on patient satisfaction (e.g. in Denmark, Great Britain, USA, Canada, Norway, Netherlands). Other countries (e.g. Ireland, Czech Republic, Estonia, Spain, Israel, Slovenia, Lithuania) perform sporadic patient satisfaction studies on a national or separate institutional level. Such examples illustrate that information about patient experience is a well acknowledged and widely used meter of health service quality.

Despite the wide range of international surveys, that measure patient satisfaction on health care services quality, getting more attention, still many studies stay national, i.e. adjusted to the national specifications of the country examined. This way the comparability of the results of these national studies is not only difficult due to different cultural and socio-economic aspects (e.g. attitudes towards health, level of unemployment, financial crisis etc.) that are important in a national level studies, but also limited by different expectations towards health care services, different features of national health care system model etc.

Despite those methodological limitations, the comparison of patient satisfaction surveys in different countries is very important in improving national health care systems and for learning from the examples of "good practice" in other countries [4].

 

AIM OF THE STUDY

The study aims to evaluate the results of the studies made on the access and quality of health care systems by the opinion of the patients in 10 EU countries on an international perspective, as well as, to find out which countries evaluate their service quality and access best, and which countries could stand out as good example for Lithuania and Romania.

 

 

METHODS

The method of systematic review and comparative analysis was adjusted in the study.

The comparative analysis of the data from the European surveys, performed since 2007 till 2010 were used in order to compare the indicators of patient's satisfaction with the access and quality of health care system in 10 EU countries. The 10 countries selected were Austria, Germany, Denmark, Sweden, Estonia, Latvia, Lithuania, Romania, UK and Slovenia. These countries were chosen for international comparison due to several reasons. Most new EU member countries still apply the mixed health care system management and financing model, which integrates both aspects of the classical "Bismarck" and the socio-economic "Beveridge" models.

 

The development of their health systems encounters with major political, economic, social and public health problems. That is why it was interesting to compare countries that apply this model to the ones that do not.

Due to compare health service access and quality indicators by patient opinion, there were purposely selected specific countries that base their health care system management and financing more on the first (Germany, Austria) or second model (Sweden, Denmark, UK) or merge characteristics from both models (Estonia, Latvia, Lithuania, Slovenia, Romania). The second criteria of choice were the share of GDP (Gross Domestic Product) for health care expenditures: countries that allocate the same of bigger share of GDP for health care expenditures as Lithuania and Romania were included. The inclusion of Estonia and Slovenia was induced by the presumption that recent successful reforms in health care sector were reflected in the results of patient satisfaction.

The search of literature was executed through data bases Pubmed, MEDLINE, PsycINFO and EBSCO, using keywords "patient satisfaction", "patient survey", "medical staff survey", "patient quality", "staff satisfaction", "patient experience" and the filter of publication date (the research had to be carried out not before the period 2007, and last year at the latest).

The selection of literature was made by several criteria:

         The research had to be carried out during the period 2007 - 2010 (based on the data of publication, because not all dates of the execution were presented);

         The representative research sample of public opinion; (Austria - 1009; Estonia - 1004; Denmark - 1007; UK - 1313; Germany - 1510; Lithuania - 1017; Latvia - 1010; Slovenia - 1037; Sweden - 1001; Romania - 1004);

         The research had to be carried out on an international scale (i.e. in all comparable countries). National level analyses were not included into the study due to the lack of comparability (these researches use different methodologies, samples, health care services are defined differently etc., that make the cross-country analysis impossible);

         The target group of the study had to be health care service users (inhabitants of the country), surveys with specified target groups (such as AIDS patients, patients with diabetes etc.) were excluded.

 

After the analysis of the literature, four international surveys matched the above stated criteria: Three Standard Eurobarometer surveys and Health Consumer Index. The cross-country analysis of 10 selected countries and the indicators of their health care service quality and access were executed, based on the variables from these surveys.

 

When comparing health care services among the selected 10 EU countries, it becomes obvious that health care results reflect very different financial investments into health care sectors there. The expenditures for health care per one inhabitant reflect the real country's investment into health sector, but in this case they cannot be used as an indicator for comparison among countries, because usually countries that have bigger financial capacity for health care also have more expensive health care services.

Therefore, seeking to get the more objective comparison among countries we added one more variable.

The indicator of financial expenditures was selected the share of GDP, allocated to health care in the country (public and private expenditures, data from 2007 were taken specifically seeking to avoid the influence of economic crisis; source: WHO). A scatter diagram using SPSS statistical package program was used to prove or disprove cause-and-effect relationships.

 

 

FACTS AND FINDINGS

The Standard Eurobarometer is a series of public opinion surveys regularly performed on the behalf of the European Commission producing the reports of more than 30 European countries. The surveys investigate the public opinion of EU inhabitants on various political, social, cultural, economic and other questions, e.g.: view on climate change, corruption, gender equality, science and technology, smoking, road safety etc. The surveys are conducted in all EU member countries, by questioning representative sample of inhabitants, older than 15 years, selected by the method of multi-scale probability sampling. The survey is conducted in the national language by the method of direct "face-to-face"interview at the residence of the inhabitants.

 

A. General evaluation of health care system

In 2009 executed special survey "Patient safety and quality of healthcare" (Eurobarometer, 2009) respondents were asked how they in general evaluate health care service quality in their country [5]. According to the results of this survey, two thirds of the EU inhabitants (70 %) positively evaluate general health care system in their country. However, in Lithuania the number of same answers is just slightly above one third (only 40 % evaluate positively). Comparing Lithuania to other selected countries we can notice that Lithuanian inhabitants evaluate their health care system significantly poorer than the inhabitants of many other selected countries (69-95 %) and only a little bit better than the inhabitants of Latvia (37 %) and Romania (25 %) see Figure1. It should be noticed that this survey was carried out therefore a negative evaluation of Lithuanian, Latvian and Romanian health care systems could partly be predetermined by the effect of the economic crisis towards the inhabitants' quality of life in general. Moreover, negative influence towards the evaluation of health care system could be made by the consequences of various measures of savings in the sphere of social protection taking into account that systems of health care and social protection are closely interwined.

When being asked to compare their health care system to the other member countries, every one third of EU inhabitants evaluate their health system better than in other EU countries. Most often positively evaluated health care system by their inhabitants is the one that is positively evaluated comparing to others as well: inhabitants of Austria, Sweden, Denmark, and Germany evaluate their health care systems positively in their countries and nearly half of the respondents think that their system is better than in other countries (Denmark has 42 % of such respondents, Austria - 64 %). Meanwhile, nearly 1/2 of Lithuanian inhabitants (47 %) and 2/3 of Romanian (73%) point out that the health care system in their country is worse than in other EU countries (Figure 2).

 

Figure 1. How would you evaluate the overall quality of healthcare in your country?

Source: European Commission (2009). Special Eurobarometer 327: Patient safety and quality of healthcare.

 

 

Figure 2. Based on what you know, do you think that the quality of healthcare in your country compared to other Member States is ?

Source: European Commision (2009). Special Eurobarometer 327: Patient safety and quality of healthcare.

 

B. Evaluation of health care service quality and access

In 2007 executed special survey "Health and long-term care in the European Union" respondents were asked to evaluate health care service quality and access, based on their knowledge and experience [6]. Hospital, out-patient specialists (medical and surgical specialists) and family doctor (or GP - general practice) medical services were being evaluated.

 

Evaluation of hospital services

Hospital service quality is positively evaluated by more than two thirds of the EU inhabitants (71%). Highest marks among the comparable countries for hospital services were given by Austrians and Swedes, and lowest by Latvians, Lithuanians and Romanians (accordingly 92-90 % and 42-57% of inhabitants evaluate services very good). Hospital services as most accessible are considered by the inhabitants of Austria and Germany, and least accessible - by Estonians (55%) and Romanians (63%). Lithuanians, Slovenians and Latvians evaluate their access to the hospitals in the same level (64-65 percent of respondents evaluate it positively). When answering the question are hospital services financially affordable for patients, positive answers were given by the majority of Swedes (86%) and only by a quarter of UK (26%) inhabitants.

The opinion of Lithuanian inhabitants in terms of organizational service quality and accessibility is significantly worse than the EU average, however, in terms of economic affordability - very near the EU average. (Table 1)

Respectively only 1 % of Lithuanian inhabitants had refused from treatment during the past 12 months due to high financial burden in Lithuania in the same survey. Meanwhile the financial burden overall influenced 3 % of the EU inhabitants to refuse from medical treatment.

 

Table 1. Evaluation of hospital based care by opinion of respondents

 


Country

Quality

Access

Affordability

Austria

92

92

79

Sweden

90

68

86

Denmark

85

74

50

Germany

79

87

66

UK

77

80

26

Slovenia

76

64

35

EU27

71

76

55

Estonia

67

55

54

Lithuania

57

65

54

Latvia

55

64

71

Romania

42

63

45

(Answers "good" or "accessible", or "affordable" in percent)

Source: European Commission (2007). Special Eurobarometer 283: Health and long-term care in the European Union

 

 

In general all in-patient health care services according to both quality and accessibility criteria in all comparable countries are best evaluated by Austrians, where patients consider these services to be good both in terms of quality and access. Quality and organizational accessibility are also positively evaluated in Germany and Denmark, however, hospital services according to their economic aspect are harder accessed in Denmark than the EU average, that is why the general score for service accessibility is not high there.

This way Swedish model excels as the leading, where economic service accessibility is evaluated the best comparing to other countries.

 

When comparing Lithuanian hospital services to the ones in the Baltic States and Slovenia, patients note that hospital services in Slovenia and Estonia are considered as more qualitative than in Lithuania. However, Estonians, Latvians and Slovenians consider their hospital services as less accessible in terms of organizational and economic sense, than do Lithuanian inhabitants.

 

Evaluation of medical specialist services

Three quarters of EU citizens evaluate specialized out-patient health care service quality as good. Austria is again the leading country according to service quality, and the lowest rates are given to Lithuanian and Latvian medical specialist services.

Medical specialist out-patient services are most accessible to Germans, and the least - to Swedes and Slovenians. The inhabitants of Sweden evaluate the economic accessibility to specialized out-patient medical services as best comparing to other countries. Meanwhile, even four out of five inhabitants of UK find difficulties to access these services in their country.

62 % of Lithuanians evaluate medical specialist out-patient service quality as good, 58 % consider them accessible to inhabitants, and 44 % indicated them as financially affordable. Lithuanian medical specialist health care service quality together with the in-patient health care services still concede to those in many other EU countries; however the accessibility is rather close to the EU average. (Table 2)

 

Table 2. Evaluation of medical and surgical specialist's services by opinion of respondents

 


Country

Quality

Access

Affordability

Austria

87

67

48

Germany

77

71

55

Denmark

75

54

42

Slovenia

75

39

26

EU27

74

62

42

Sweden

71

38

65

UK

71

61

21

Estonia

68

41

41

Lithuania

62

58

44

Latvia

61

53

66

Romania

59

52

29

 

 

 

 

(Answers "good" or "accessible", or "affordable" in percent)

Source: European Commission (2007). Special Eurobarometer 283: Health and long-term care in the European Union

 

 

Giving general evaluation about medical specialist out-patient services according to both criteria of quality and accessibility, the leading countries are Germany and Austria, the latter which was evaluated positively by the patients in terms of both quality and accessibility. Both countries also have these services as most financially affordable than the EU average.

 

Evaluation of GP (family doctor's) services

GP service quality is better evaluated by the patients, than specialized medical out-patient or in-patient services in general, according to the EU average: 84 % of EU inhabitants consider GP service quality as good. The poorest quality of GP services is evaluated in Sweden (68 %). 77 % of Lithuanian and 71 % of Romanian inhabitants evaluate GP service quality as good.

 

GP services are more accessible than hospital (in-patient) or medical specialist health care services, and more than a half of inhabitants in all comparative countries evaluate the economic affordability of these services as good (except in UK and Slovenia). Inhabitants of the UK consider their GP and specialized out-patient care services as less economically affordable. Meanwhile, in Lithuania this indicator is higher than the EU average. (Table 3)

 

Table 3. Evaluation of family doctors services by opinion of respondents

Country

Quality

Access

Affordability

Austria

93

94

78

Denmark

91

82

51

Germany

88

94

83

UK

88

86

26

EU27

84

88

66

Slovenia

84

86

47

Estonia

78

89

74

Lithuania

77

80

77

Latvia

72

73

91

Romania

71

77

69

Sweden

68

63

82

(Answers "good" or "accessible", or "affordable" in percent)

Source: European Commission (2007). Special Eurobarometer 283: Health and long-term care in the European Union

 

Giving general evaluation about GP services according to both criteria of quality and accessibility, the leading countries are Germany and Austria again, where patients evaluate these services most positively in terms of quality and access. GP service quality is also positively evaluated in Denmark, but the accessibility of these services is harder than the EU average (especially in terms of economic affordability). The worst evaluated GP services among comparable countries are those in Sweden - in both terms of quality and access.

 

2. Health Consumer Index

The Health Consumer Powerhouse (HCP) organization was launched in 2005 in Brussels, which monitors and compares healthcare systems among 35 countries (including all EU member countries and Canada), according to the 38 indicator system. The Health Consumer Index (HCI) ranks 33 national European health care systems across 38 indicators, covering six areas that are key to the health consumer: Patients' rights and information, e-Health, Waiting times for treatment, Treatment outcomes, Range and reach of services provided and Access to medication. The Index is compiled from a combination of public statistics, patient surveys and independent researches conducted by the founders - Brussels-based Health Consumer Powerhouse.

 

Indicators of measurement reflect not the input to the health care system, but the results gained, according to patients' opinion, i.e. not the infrastructure of the system, but what kind of care is received by the patients in a particular country.

The HCI is supported by the Directorate General for Information Society and Media (e-Health) of the European Commission. Every indicator is measured according to relevant, reliable and publicly available data [7, 8].

 

The results of the research, made in 2009 and 2010, on health service quality and accessibility in the spheres of Patients' rights and information, e-Health, Waiting times for treatment, Range and reach of services provided, are listed below. Every indicator, according to its size and limits, is measured on a three-point scale: "good" (pink), "average" (white), "bad" (dark red). Additionally, the evaluation of every health care system in a specific country is presented according to the general score point in every sphere measured (the maximum score points for the sphere on "Patient's rights" is 150, for "Waiting times for treatment" - 250, for "Range and reach of services provided" - 150). For a better comparison we also present more detailed characteristics of a top-score country according to separate indicators and score points.

 

A. Patient's rights.

The assurance of patient's rights, which is one of the guarantees for health care service quality, is measured by 10 indicators in the research [8]. Patient's rights among the comparable countries are best ensured in Denmark: the health care system of this country got highest scores in every indicator measured (150 score points out of 150) (table 4). Denmark has the law on Patient's rights, the members of patient organizations are included into the political decision making process, patients are insured from medical errors, are entitled to a second opinion and can access their medical records without any boundaries.

This country has not only the existing registry of licensed doctors, but also the catalog of health care providers with the evaluations of their provided services; patients can get the advice of any health care professional anytime, most GPs store patient data in electronic medical cards and the treatment abroad is funded from the national health insurance fund.

Lithuanian health care system is also evaluated well in terms of patient's rights (110 score points out of 150). Comparing to Denmark, Lithuania is lagging behind in the field of e-health (electronic medical cards, internet or telephone patient consultation anytime). The transparency in selection of health care service providers is in need of improvement (the catalog of health care providers with the evaluations of their provided services, simpler terms for the funding of treatment abroad). The detailed indicators of all comparable countries are provided in tables below.

 

B. Waiting time for treatment

Waiting time for treatment is one of the indicators of organizational accessibility. The waiting time for a doctor or for the specific intervention is evaluated by 5 indicators: same day access to family doctor, direct access to specialist (since the research is on patient's opinion, the absence of dispatches is considered as positive indicator), waiting time for planned surgeries: major non-acute operations <90 days, for cancer therapy < 21 days and CT scan and other diagnostic procedures < 7days.

According to these indicators, Germany and its health care system was rated on top (233 score points out of 250) (table 5). Despite the fact that the access to GPs is sometimes not at the same day in Germany, but therefore it is possible to have direct access to specialist doctor consultation (consumer sees it as a positive indicator), most waiting times for a planned surgeries (non-acute operations) are no longer than 3 months, cancer therapy usually starts earlier than in three weeks from the dispatch and CT scans are done within a period of one week. Indicators of waiting time are also respectable in Austria, which has a similar health care system model of management and financing as Germany.

These indicators in other countries are significantly lower. Same day access to the GP is available only in Slovenia; meanwhile having such access in Denmark, Estonia and Lithuania is not always possible. In many countries, except for Latvia and Lithuania, the increase of the effectiveness of health care system through the reforms resulted in positive outcomes in terms of a purposeful regulation of patient flows, seeking to decrease the direct access to specialist doctors. These means of regulation are still not yet fully implemented in Latvia and Lithuania, therefore direct access to specialist doctors is still possible.

At least half of the patients in Denmark, Estonia, Lithuania and Sweden have shorter than 3 month waiting time for non-acute operations, meanwhile Latvia, Slovenia and UK indicate longer than 3 month periods for such interventions.

Nearly all countries indicate longer than 3 weeks waiting times for cancer therapy, except for Slovenia and Latvia, whereas almost 90 % of such procedures start earlier.

Most complicated sphere in all countries is with CT scans and other diagnostic procedures that often have longer waiting times than 3 weeks. The situation is a little better only in Latvia, Estonia and Denmark where waiting times for CT scans are from one to two weeks respectively.

In conclusion, health systems of Germany and Austria are leading according to waiting times.

The worst situation of this kind according to the patients is in Sweden and UK, due to the long waiting time for doctors and non-acute surgeries or diagnostic procedures (117/250 and 100/250 score points respectively). Despite this, Slovenia stands out positively by 2 indicators: same day access to GP and relatively shorter waiting times for cancer therapy. Lithuania has average scores for waiting times (150/250), whereas Romania - 120/250 points.


C. Range and reach of services

The range and reach of services are evaluated by 6 measured indicators according to the benefit for patients (cataract operations per 100 000 age over 65, infant 4-disease vaccination, kidney transplants per million population, if dental care included in the funded healthcare package, rate of mammography, informal payments to doctors) and evaluated differently within the analyzed countries (table 6). The highest scores in this category were estimated in Sweden, meanwhile this indicator is below 3000 operations in Lithuania (see table 6). Same amount of attention among the comparable countries in the sphere of infant 4-disease vaccination is drawn in Sweden, Latvia and Slovenia, whereas this indicator is up to 92-97 % in Lithuania.

Kidney transplants per million populations are mostly available for patients in Austria, Estonia and Sweden, while this indicator Lithuania is the lowest - less than 30 operations per million inhabitants. Dental care, included in the funded healthcare package, is in Austria, Denmark, Slovenia, UK and Germany, meanwhile Romania and Lithuania has these services funded only partially.

Indicators of rate of mammography are best in Sweden: preventive diagnostics is available to more than four-fifths of women population in this country. However, the rate of mammography is less than 60 % in Lithuania.

Informal payments, as a negative indicator of service accessibility, are noticed only in Lithuania, Romania and Latvia, where it is still used as a common patient practice. Informal payments sometimes still occur in Estonia and Austria, meanwhile other comparable countries do not face this problem and this indicator is evaluated as the best aspect of service accessibility there.

According to the overall evaluation of range and reach of services, Lithuania is at the end of the list among the comparable countries (67/150 points).

 

Overall, even four out of six health care indicators in this sphere are evaluated very poorly, according to the perspective of Lithuanian patients.

 

Therefore, even though Lithuania allocates the similar share of GPD to health care as Latvia or Estonia, the range and reach of services is significantly lower in Lithuania.

 

Table 4. Assurance of patient's rights according to selected countries and indicators

 

 

 

 

Table 5. Waiting time according to selected countries and indicators

Source: Eisen, B. and Bjornberg, A. (2010). Euro-Canada Health Consumer Index 2010. Frontier Centre for Public Policy & Health Consumer Powerhouse.

 

Generalization and discussion

The overall indicator of service quality was calculated using data from The Standard Eurobarometer on hospital, out-patient specialists (medical and surgical specialists) and family doctor (or GP - general practice) medical service quality evaluation (arithmetic average in all three services evaluated as "good" or "very good").

The evaluation of health care services in respect to this derivative indicator of quality and financial resources among 10 EU countries is presented in the picture below (see Figure 3).

The overall evaluation shows, that the relation between the invested resources and health care service quality is rather strong - countries that have bigger share of GDP allocated to health care, have better evaluated health care service quality and vice versa. Romania, Lithuania and Estonia are lagging behind on allocation of financial resources to health care and on the evaluation of service quality indicators. However, Estonian case is worth more attention and detailed investigation, due to the fact that despite the financial investments to health care being lower, the inhabitants of Estonia still evaluate their health care service quality better than Latvians or Lithuanians.

Romania in this case is ahead of Latvia by having rather poor resources to health care in respect to health care service quality as well.

Overall service accessibility indicator was calculated according to the results from Health Consumer Index, i.e. by drawing the average score for every country from the two spheres of service accessibility (waiting time for treatment and the range and reach of services). The overall evaluation of health care services in respect to the derivative indicator of accessibility and financial resources among 10 EU countries is presented in the picture below (see Figure 4). Similarly as in service quality evaluation, countries that allocate more resources to health care also secure a relatively higher accessibility rates, although this relation is not that tight: Inhabitants of Denmark and Sweden have only moderately easier accessible services despite the fact that these countries allocate higher share of GDP to health care. In addition, health care service accessibility rate in UK is also lower than average.

As well as in case of service quality, Estonia excels in assuring a moderate health care service accessibility having relatively low financial resources.

 

The overall score number for every country in the sphere of patient's rights and information (having big value on quality evaluation) was chosen as the indicator of the assurance of patient's rights and information according to Health Consumer Index. The overall evaluation of health care services in respect to the derivative indicator of patient's rights and information and the financial resources among 10 EU countries is presented in the picture below (see Figure 5). It shows that Lithuania has made a progress in the sphere of patient's rights and information. Nonetheless that Lithuania has significantly low resources for health care in general; the assurance of patient's rights and information are in the same level as those of the UK, Germany and even better than Sweden - countries with more financial capacities allocated for health care.

 

The worst evaluation of patient's rights and information is received by the inhabitants of Romania and Latvia, despite of the example of Lithuania and Estonia showing that it can be improved even without big investments.

 

 

Evaluation of Health care system

The overall evaluation of Health care systems according to the inhabitants of Lithuania and Romania are evaluated significantly worse than those of by other countries: only 40 % of Lithuanians and 25 % of Romanians see their health systems as good, meanwhile this indicator is between 69-95 % in other countries. Austrians evaluate their health care system as good by 95 %, Swedes - by 90, Danish - by 87, Germans - by 86, UK - 86, Estonians - 70, Slovenians - 69. Lithuanians, Latvians and Romanians evaluate their health care systems worse than European Union average (accordingly 40, 37, 25 % of population evaluate it as good). Almost half of the Lithuanian inhabitants (47 %) think that Lithuanian health care system is worse than in other EU countries. 65 % of Latvians and 73 % of Romanians also thing the same [5].

 

Figure 3. Evaluation of health care quality according to health care expenditures (% of positivive evaluations, GDP for health care in %)

(1 - Germany; 2 - Austria; 3 - Denmark; 4 - Sweden; 5- Lithuania; 6 - Romania; 7 - UK; 8 - Slovenia; 9 - Estonia; 10 - Latvia)

 

Figure 4. Evaluation of health care access by health care expenditures

Figure 5. Evaluation of patients rights according to health care expenditures

 

(1 - Germany; 2 - Austria; 3 - Denmark; 4 - Sweden; 5- Lithuania; 6 - Romania; 7 - UK; 8 - Slovenia; 9 - Estonia; 10 - Latvia)

 

 

Evaluation of Health care quality

An average of 71 % of EU inhabitants evaluated hospital service quality as good in 2007; this indicator is 57 % in Lithuania. It shows that hospital service quality in Lithuania is evaluated only a little better than in Latvia and Romania (55 and 42 % respectively). Medical or surgical specialist service quality is evaluated as "good" by an average of 74 % of the EU inhabitants, by 62 % of Lithuanian inhabitants, 61 % of Latvians and 59 % of Romanians. Family doctor service quality is evaluated as "good" by an average of 84 % of EU inhabitants and 77 % of Lithuanians. However, Latvians, Swedes and Romanians evaluated their family doctor service quality even worse than Lithuanians [6].

According to the indicator on patient's rights and information, Lithuanian health care system is evaluated as rather good. Denmark is the leading country in EU in the sphere of e-health (electronic medical cards, internet or telephone patient consultation anytime), comparing to which Lithuania is lagging behind. The transparency in selection of health service providers is in need of improvement (the catalog of health care providers with the evaluations of their provided services, simpler ter-ms for the funding of treatment abroad) [7].

 

Evaluation of health care accessibility

Hospital services as accessible were evaluated by 76 % of EU inhabitants and by 65 % Lithuanians in 2007 [6]. Harder accessed hospital services, according to the patients, are in Estonia, Slovenia, Latvia and Romania. Inhabitants of Denmark and Sweden also evaluate their hospital accessibility worse than EU average. Economically in-patient health care services seem of the same availability as to the average European (55 %), meanwhile patients of Slovenia, Denmark, UK and Romania have more financial difficulties in accessing them than patients in Lithuania.

Specialized out-patient health care services are accessible to 58 % of Lithuanians. This evaluation is better than in Denmark, Latvia, Estonia, Slovenia, Sweden and Romania. Moreover, according to the EU average, the accessibility to medical and surgical specialists is better only in Germany out of all 10 countries. Financially medical and surgical specialist services in Lithuania are even more accessible than the EU average. Nevertheless, Germany, Austria, Sweden and Latvia could still be the examples of better economic accessibility for Lithuania.

Access to GPs is rather high in Lithuania: 80 % of the inhabitants think that GP services are accessible (84 % EU average). Economically GP services are also better accessed than the EU average.

This indicator is better only according to the inhabitants of Germany, Austria, Sweden and Latvia.

 

The accessibility according to the waiting time is evaluated as average in Lithuania comparing to other 9 countries. Lithuania still has to improve the same day access to doctor, waiting time for planned surgeries and cancer therapy, but mostly - the sphere of CT scans and other diagnostic procedures.

 

However, range and reach of services are evaluated the worst in Lithuania from all comparable countries except Romania. In this respect, Lithuania still lacks the attention to infant 4-disease vaccination, dental care, which is still only partially included in the funded healthcare package, and especially - to cataract surgeries over 65, kidney transplantations, mammography and informal payments to doctors. All these sphere need most improvement in terms of service accessibility in Lithuania.

 

Value for money-adjusted evaluation

In general the relation between the investments to heath care and health care service quality and accessibility is rather strong. Countries that allocate larger share of GDP to health care have better evaluations of service quality and accessibility and vice versa.

 

Comparing to many other countries Lithuania is still short on financial resources for health care and the evaluation of service quality and accessibility goes in line with this factor accordingly. However, even though Lithuania lacks financial resources for health care, the sphere of patient's rights is in line with such countries as UK, Germany and even better than in Sweden - countries that have way bigger budgets and financial capacities in this sector.

 

CONCLUSION

Although on average, most respondents rate the quality of healthcare in their country as good or very good, significant variation is observed at the country level, especially in those of Central and Eastern Europe. Majority respondents in Austria and Sweden rate their healthcare system as good, but only a quarter of respondents in Romania and less than a half in Lithuania consider the quality of healthcare in their country as good or very good. Could be, that financial and economic crisis has influenced those results.

T hose who rate their country's healthcare positively also tend to feel the quality is better than that available in other Member States. One third of the respondents feel that the quality of healthcare in their country is better than in another Member State. Respondents in Austria lead the way. A further quarter of Europeans tend to think that healthcare in their country is worse than in other EU Member States, most notably in Romania (two thirds).

The access to health care is the best evaluated in Austria and Germany, the worst in Latvia, Romania Lithuania and Estonia. Sweden provides the worst access among the evaluated countries to family doctors, Estonia - to the hospitals.

Overall assessment of quality and access in ten selected European countries considering value for money-adjusted evaluation show that in terms of health care quality leads Austria, Denmark and Germany, the worst quality is evaluated in Latvia, Romania, Lithuania and Estonia. In terms of health care access leads also Germany Austria and Denmark and Lithuania, Romania, Latvia and Estonia are lagging behind.

Given the significant differences in perception of healthcare quality among EU citizens on the one hand, and the wish for equal access to good quality care on the other, it is clear that there is room for reflection on how to reduce the observed disparities between countries.

 

 

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