Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T22:56:51.959Z Has data issue: false hasContentIssue false
  • English
  • Français

Access Compromised? The Impact of Healthcare Reforms under Austerity in Lithuania and Spain

Published online by Cambridge University Press:  21 February 2020

Sigita Doblytė  and
Ana M. Guillén
Sigita Doblytė
Affiliation:
Department of Sociology, University of Oviedo, Oviedo, Spain E-mail: [email protected]
Ana M. Guillén
Affiliation:
Department of Sociology, University of Oviedo, Oviedo, Spain E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Using an interpretative comparison in search for cross-case similarities and differences, we examine the evolution of equity of access to healthcare during the economic crisis in two potentially vulnerable Eastern and Southern European countries – Lithuania and Spain. While the type of healthcare system may have shown higher resilience, i.e. equity of access to care during the crisis should have been affected more in Lithuania – a relatively immature health insurance system – than in Spain – a consolidated national health service, the intensity and length of the crisis and types of adjustment measures undertaken may have led, in turn, to different results in terms of equity of access. The analysis focuses on the respective institutional designs and healthcare reforms under austerity as well as subjective and objective indicators of access to care. We conclude that the Lithuanian healthcare system, despite potential comparative disadvantage, has shown greater performance than the Spanish one during the crisis.

Keywords

Access to healthcarecrisissubjective/objective indicatorsLithuaniaSpain
Type
Articles
Information
Social Policy and Society , Volume 19 , Issue 4 , October 2020 , pp. 521 - 537
Copyright
© Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blank, R. H. and Burau, V. (2010) Comparative Health Policy, New York: Palgrave Macmillan.Google Scholar
Baeten, R., Spasova, S., Vanhercke, B. and Coster, S. (2018) Inequalities in Access to Healthcare. A Study of National Policies 2018, Brussels: European Commission, DG Employment, Social Affairs and Inclusion-ESPN.Google Scholar
Cockcroft, A., Andersson, N., Paredes-Solís, S., Caldwell, D., Mitchell, S., Milne, D., Merhi, S., Roche, M., Konceviciute, E., and Ledogar, R. J. (2008) ‘An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States’, BMC Health Services Research, 8, 15.CrossRefGoogle ScholarPubMed
Cylus, J. and Papanicolas, I. (2015) ‘An analysis of perceived access to health care in Europe: how universal is universal coverage?’ Health Policy, 119, 9, 1133–44.CrossRefGoogle ScholarPubMed
Cylus, J. and Pearson, M. (2015) ‘The crisis and its implications for household financial security, government resources and health expenditure’, in Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., Cylus, J., Karanikolos, M. and Kluge, H. (eds.), Economic Crisis, Health Systems and Health in Europe: Impact and Implications for Policy, Berkshire: Open University Press, 17–50.Google Scholar
Drummond, M. and Towse, A. (2012) ‘Is it time to reconsider the role of patient co-payments for pharmaceuticals in Europe?’ The European Journal of Health Economics, 13, 1, 1–5.CrossRefGoogle ScholarPubMed
Economic Policy Committee, Ageing Working Group and Commission Services (2016) ‘Joint report on health care and long-term care systems and fiscal sustainability: volume 1’, European Economy Institutional Paper 037.Google Scholar
Eurobarometer (2014) ‘Corruption: report’, Special Eurobarometer 397, Wave EB79.1, Brussels: TNS Opinion & Social.Google Scholar
Eurobarometer (2017) ‘Corruption: report’, Special Eurobarometer 470, Wave EB88.2, Brussels: TNS Opinion & Social.Google Scholar
Eurofound (2014) Access to Healthcare in Times of Crisis, Luxemburg: Publications Office of the European Union.Google Scholar
Eurostat Statistics (2019) Public-Use Database of the Statistical Office of the European Union, https://ec.europa.eu/eurostat/data/database.Google Scholar
Freeman, R. (2000) The Politics of Health in Europe, Manchester: Manchester University Press.Google Scholar
García-Armesto, S., Abadía-Taira, M. B., Durán, A., Hernández-Quevedo, C. and Bernal-Delgado, E. (2010) ‘Spain: health system review’, Health Systems in Transition, 12, 4, 1–295.Google ScholarPubMed
Garuoliene, K., Alonderis, T. and Marcinkevicius, M. (2011) ‘Pharmaceutical policy and the effects of the economic crisis: Lithuania’, Eurohealth, 17, 1, 1–4.Google Scholar
Gemmill, M. C., Thomson, S. and Mossialos, E. (2008) ‘What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries’, International Journal for Equity in Health, 7, 12.CrossRefGoogle ScholarPubMed
Guillén, A. M. (2002) ‘The politics of universalisation: establishing national health services in Southern Europe’, West European Politics, 25, 4, 49–68.CrossRefGoogle Scholar
Guillén, A. M. and Cabiedes, L. (1997) ‘Towards a national health service in Spain: the search for equity and efficiency’, Journal of European Social Policy, 7, 4, 319–36.CrossRefGoogle Scholar
van Ginneken, E., Habicht, J., Murauskiene, L., Behmane, D. and Mladovsky, P. (2012) ‘The Baltic states: building on 20 years of health reforms’, British Medical Journal, 345, e7348.CrossRefGoogle ScholarPubMed
Hassenteufel, P. and Palier, B. (2007) ‘Towards neo-Bismarckian health care state? Comparing health insurance reforms in Bismarckian welfare systems’, Social Policy and Administration, 41, 6, 574–96.CrossRefGoogle Scholar
Hernández-Quevedo, C. and Papanicolas, I. (2013) ‘Conceptualizing and comparing equity across nations’, in Papanicolas, I. and Smith, P. C. (eds.), Health System Performance Comparison: An Agenda for Policy, Information and Research, Berkshire: Open University Press, 183–222.Google Scholar
Jowett, M., Thomson, S. and Evetovits, T. (2015) ‘Changes to public funding for the health system’, in Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., Cylus, J., Karanikolos, M. and Kluge, H. (eds.), Economic Crisis, Health Systems and Health in Europe: Impact and Implications for Policy, Berkshire: Open University Press, 51–77.Google Scholar
Kacevicius, G. and Karanikolos, M. (2014) The Impact of the Financial Crisis on the Health System and Health in Lithuania, Copenhagen: WHO/Europe.Google Scholar
Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., Mackenbach, J. P. and McKee, M. (2013) ‘Financial crisis, austerity, and health in Europe’, Lancet, 381, 1323–31.CrossRefGoogle ScholarPubMed
Kasiulevičius, V. and Lember, M. (2015) ‘Lithuania’, in Kringos, D. S., Boerma, W. G. W., Hutchinson, A. and Saltman, R. B. (eds.), Building Primary Care in a Changing Europe: Case Studies, Copenhagen: European Observatory on Health Systems and Policies, 155–61.Google Scholar
Kornai, J. and Eggleston, K. (2001) Welfare, Choice and Solidarity in Transition: Reforming the Health Sector in Eastern Europe, Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Law on Health Insurance (1996) Republic of Lithuania, 21.05.1996, No I-1343.Google Scholar
Lazutka, R., Skučienė, D., Černiauskas, G., Bartkus, A., Navickė, J., and Junevičienė, J. (2013) Socialinis draudimas Lietuvoje: kontekstas, raida, rezultatai [Social Insurance in Lithuania: Context, Development, Results], Vilnius: Lietuvos Socialini Tyrim Centras.Google Scholar
Murauskiene, L., Janoniene, R., Veniute, M., van Ginneken, E. and Karanikolos, M. (2013) ‘Lithuania: health system review’, Health Systems in Transition, 15, 2, 1–150.Google ScholarPubMed
MISSOC (2018) Mutual Information System on Social Protection: Comparative Tables, https://www.missoc.org/missoc-database/comparative-tables/Google Scholar
National Audit Office of Lithuania (2011) ‘Privalomasis sveikatos draudimas [Compulsory health insurance]’, Public Audit Report, Vilnius.Google Scholar
National Audit Office of Lithuania (2013) ‘Ar efektyvi šeimos gydytojo veikla? [Efficiency and effectiveness of the family doctor’s work]’, Public audit report, Vilnius.Google Scholar
National Statistics Institute of Spain (2018) INEbase: Total Expenditure and Average Expenditure of Households, https://www.ine.es/dynt3/inebase/en/index.htm?padre=1998&capsel=2003.Google Scholar
OECD/EU (2016) Health at a Glance: Europe 2016 – State of Health in the EU Cycle, Paris: OECD Publishing.Google Scholar
OECD (2014) Health at a Glance: Europe 2014, Paris: OECD Publishing.Google Scholar
OECD (1987) ‘Financing and delivering health care: a comparative analysis of OECD countries’, OECD Social Policy Studies, 4, Paris: OECD.Google Scholar
Official Statistics Portal of Lithuania (2018) Indicators Database: Household Budget Survey, https://osp.stat.gov.lt/en/statistiniu-rodikliu-analize#/.Google Scholar
Palier, B. (2010) ‘Ordering change: understanding the ‘Bismarckian’ welfare reform trajectory’, in Palier, B. (ed.), A Long Goodbye to Bismarck? The Politics of Welfare Reforms in Continental Europe, Amsterdam: Amsterdam University Press, 19–44.CrossRefGoogle Scholar
Petmesidou, M., Pavolini, E. and Guillén, A. M. (2014) ‘South European healthcare systems under harsh austerity: a progress-regression mix?’ South European Society and Politics, 19, 3, 331–52.CrossRefGoogle Scholar
Reibling, N. (2010) ‘Healthcare systems in Europe: towards an incorporation of patient access’, Journal of European Social Policy, 20, 1, 5–18.CrossRefGoogle Scholar
Sitek, M. (2010) ‘The new institutionalist approaches to health care reform: lessons from reform experiences in Central Europe’, Journal of Health Politics, Policy and Law, 35, 4, 569–93.CrossRefGoogle ScholarPubMed
Spanish Economic and Social Council (2011) ‘Memoria sobre la situación socioeconómica y laboral de España en 2010 [Report on the socioeconomic and labour situation of Spain in 2010]’, Colección Memorias 18, Madrid.Google Scholar
Spanish Economic and Social Council (2014) ‘Memoria sobre la situación socioeconómica y laboral de España en 2013 [Report on the socioeconomic and labour situation of Spain in 2013]’, Colección Memorias 21, Madrid.Google Scholar
Spanish Economic and Social Council (2016) ‘Memoria sobre la situación socioeconómica y laboral de España en 2015 [Report on the socioeconomic and labour situation of Spain in 2015]’, Colección Memorias 23, Madrid.Google Scholar
Spanish Economic and Social Council (2017) ‘Informe sobre políticas públicas para combatir la pobreza en España [Report on public policies to combat poverty in Spain]’, Colección Informes 01/2017, Madrid.Google Scholar
Stamati, F. and Baeten, R. (2014) ‘Health care reforms and the crisis’, ETUI Report 134, Brussels: ETUI.Google Scholar
Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., and Kluge, H. (2015) ‘Making sense of health system responses to economic crisis’, in Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., Cylus, J., Karanikolos, M. and Kluge, H. (eds.), Economic Crisis, Health Systems and Health in Europe: Impact and Implications for Policy, Berkshire: Open University Press, 1–16.Google Scholar
Ventura, J. and González, E. (2013) ‘Spain: Quo Vadis? From cost containment to structural reforms’, in Pavolini, E. and Guillén, A. M. (eds.), Health Care Systems in Europe under Austerity: Institutional Reforms and Performance, Hampshire: Palgrave Macmillan, 57–80.CrossRefGoogle Scholar
Wendt, C. (2009) ‘Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare’, Journal of European Social Policy, 19, 5, 432–45.CrossRefGoogle Scholar
Wenzl, M., Naci, H. and Mossialos, E. (2017) ‘Health policy in times of austerity: a conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008’, Health Policy, 121, 947–54.CrossRefGoogle ScholarPubMed
WHO (2018) Global Health Expenditure Database, http://apps.who.int/nha/database/Select/Indicators/en.Google Scholar
WHO Regional Office for Europe (2019) European health for all database (HFA-DB), https://gateway.euro.who.int/en/datasets/european-health-for-all-database/.Google Scholar