Drakou, Ismini
(2015)
Inequalities and Inequity in utilisation of health care among the older people in Greece.
PhD thesis, London School of Economics and Political Science.
Abstract
Thirty years have passed and five major reforms have followed since the establishment of the Greek National Health System (NHS) in 1983 on universal coverage as an elementary policy goal, and the Greek NHS is still insufficient with regard to organisation, coverage, funding and delivering health services. The primary objective of the thesis is to employ quantitative empirical methods to explore some key aspects of equity in the receipt of health care in Greece among the older population via two nationwide and one urban setting datasets. This thesis comprises three essays which shed light on the equity issue before and after NHS major reforms of 2001-4 and 2005-7.
The findings of this thesis suggest that inequalities in health care exist mainly for the probability of specialist and dentist private visits. Income- related inequalities are less apparent in probability of inpatient admissions and probability of outpatient visits, favoring the less advantaged. Income itself is not the only contributor. The findings indicate intra and interregional inequalities in most of health care services use except for probability of GP visits, favoring residents of thinly-populated areas. Compared to Athens region, regional disparities-inequalities are not apparent for inpatient care, as well. Furthermore, the findings suggest that even though we signify territorial disparities in the probability of specialist visit favoring the better off, once the positive contacts of specialist visits are included, the elderly have equal probability to make a specialist private visit, irrespective of their income and their region of residence.
In addition, this thesis finds that inequalities are apparent among the Social health insurance funds (SHIFs) in use of most health care types, except the probability of inpatient admissions. Non Noble Farmers OGA SHIF - who tends to be less advantaged - has a more pronounced pro poor contribution to overall inequity in the probability of specialist private visit than the Noble SHIFs, revealing an unfair relationship. This thesis also finds that OOP expenses constitute a significant financial burden to inpatient and outpatient care. There is a regressive trend in OOP amount for inpatient admission in terms of ability to pay and region of residence favoring residents of thinly-populated areas and Central Greece region- who tend to be less advantaged. For outpatient care, there is a progressive trend in OOP amount in terms of ability to pay, SHIF coverage and region of
residence.
The thesis provides useful tools for understanding and measuring inequalities in the use of health care among the older population, who are the most constant consumers of health services. It urges policy makers to review the governance of primary health care by setting conditions and implements measures for improving efficiency, unifying SHIFunds, eliminating geographical inequalities and control the role of OOP expenses as significant
barriers to access health care, especially during the current period of economic crisis.
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