Table 6.

Induced barriers in healthcare access for elderly

Access to healthcare	Category	Effect on elderly
Affordability	Current financial situation and pension cuts	○ impoverishment of the elderly population ○ dependence on family
	Exemption allowances	○ limited access for elderly with a middle income pension and especially with chronic conditions
	Pharmaceuticals access	○ restricted affordability of pharmaceuticals ○ patients with chronic diseases: poly-medication ➔ interaction of medications ➔ all required medication cannot be afforded
	Primary care service utilization	○ increase in co-payments ➔ decrease in primary care visits
	Specialist care service utilization	○ Gate keeping system: patients need to pay both fees ➔ chronically ill elderly as main users more disadvantaged
Approachability	Rearrangement of Primary care provision	○ enhanced health provision for elderly through increased efficiency ○ still major deficiencies of a sufficient provision are reported: shortage of healthcare staff ○ difficulty to access for elderly with low mobility
	Hospital care service and emergency care	○ greater efficiency in terms of diagnostic methods and quality of care provision ○ Higher pressure for healthcare staff ➔ less time for patients ○ Hospitals not patient centred but disease centred built ➔ access deficiently for elderly with co-morbidities
	Health illiteracy	○ barrier in the appropriate usage of the service for elderly ➔ lack of understanding on the usage of health care facilities and health benefits ➔ lack of engagement of elderly ➔ lack of understanding of the GP’s instructions on adequate application of pharmaceuticals
	Integration of health sectors	○ lack of follow up care ○ unnecessary stays of elderly in hospitals
Availability	Healthcare staff	○ excessive emigration ➔ less availability of health care staff ○ ➔ lack of follow-up ○ ➔ longer waiting times
	Long-term care	○ shortage in follow-up and public long-term care (despite major improvements)
	Health Transportation and walkability	○ cuts on free of charge non-emergency patient transportations ○ alternative transport: ➔ too costly ➔ too difficult for elderly with low mobility ➔ lack of adaptations (e.g. wheelchair fixture in busses)
	Housing and isolation	○ old houses mostly do not follow universal accessibility rules ○ ➔ elevators installation missing ➔ poor housing conditions: lack of heating ➔ low mobility ➔ fear of falling
Appropriateness	Waiting times	○ increased waiting times for elective surgery (e.g. hip replacement surgery)
	Quality of care	○ higher time constraints and pressure ○ ➔ impairing quality of care: less patience
	Policy response and elderly participation	○ lack of specific policy response and priority setting at the local level ○ present health care plans: ➔ still insufficient ➔ rather unspecific ➔ lacking the focus on access to health care services