Universal Health Coverage in the EU: Are we really leaving no one behind?

kyriakides

Stella Kyriakides, European Commissioner for Health and Food Safety in Nicosia. Co-operators: Photographer: Iakovos Hatzistavrou European Union, 2020 Source: EC – Audiovisual Service.

This article was exclusively written for The European Sting by Ms. Mara Franke and Martina Steinmaurer, both medical students, representing “GandHI”, the global health project of the german medical student association. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Europe has always been a role model when talking about successful health insurance coverage. Germany and the United Kingdom are prime examples of how Universal Health Coverage [UHC] can transform society and economy. Theoretically, UHC has been implemented in all European countries(1). But how does theory relate to real life in this case?

We postulate that even in European health care systems, ranking among the health care systems with the highest per capita health care spending in the world (2), truly universal health coverage, reaching every single individual in society, has not been achieved. Many socially marginalized groups suffer from a lack of access to health care services and face a high burden of preventable diseases. Among those socially marginalized and excluded groups, homeless people face particularly substantial challenges in accessing health care: a lack of insurance and financial risk protection, a lack of knowledge and information on available health services as well as stigmatisation and prejudice when seeking care (3,4,5,6). UHC is usually funded by either tax revenues or a combination of public and private insurance and care delivery systems. Insurance for the very poor has to be covered by public funds. Therefore, emergency treatments can often be covered but follow-up or preventive care often remain unfunded. It is estimated that compared to the housed population, one year of homeless is associated with a loss of 0,117 QALYs, illustrating the substantial burden of disease and loss of well-being and health in the homeless population(7). Not surprisingly, this increases marginalization and inequality issues.

As a result of these factors, many homeless people suffer from easily preventable diseases, often of a dermatological or parasitical nature (8). According to a study conducted among the homeless population in Berlin in 2015, dermatological diseases were the most frequent health issue, affecting 35% of the study population (8).

Additionally, homeless people have a much higher rate of mental and psychiatric diseases compared to the average population (9) which hinder treatment seeking and adherence.

Especially in the care for NCDs long-term continuous therapy is crucial, even more so as NCDs such as hypertension and known risk factors such as smoking are more prevalent among the homeless than the general population (10).

The number of providers treating uninsured individuals and their reach is insufficient with respect to the population at need (8) and they face a severe lack of funding(10). Sufficient follow-up care, e.g. for wound management, especially after emergency treatment in A&E departments is almost nonexistent. This creates significant challenges down the road as wound infections and chronic wounds are some of the most prevalent diseases among homeless people(8).

Lastly, the stigma and outright discrimination homeless people experience when accessing health care can discourage further treatment seeking efforts and worsen health outcomes significantly.

With the homeless population and housing prices increasing drastically all over Europe (11), Europe’s current health care systems are neglecting the health care needs a substantial and growing part of the population they are supposed to be serving. Solutions must urgently be found to assure every single person can benefit from truly universal health coverage.

Sources

About the authors

Mara Franke and Martina Steinmaurer are both medical students, representing “GandHI”, the global health project of the german medical student association. Mara Franke is in her 9th semester, currently working on her doctorate thesis on socio- economic risk factors for malaria infection in Agogo, Ghana. he is interested in health system strengthening and social determinants of health. Martina Steinmaurer is in her final year of studies with interests in UHC and Global Surgery. With “GandHI” we are aiming to bring Global Health closer to medical students in Germany, as we advocate for global health education at medical universities, act as interest representatives and try to educate through a monthly newsletter (https://www.facebook.com/GandHIbvmd/).

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