1. The accessibility of healthcare for poor people in Slovenia Danica Rotar Pavlic, MD, PhD, Jantien Altena, medical student Pisa, 20 10

2. Contents Introduction Methods Results Discussion Conclusion

3. Introduction Health inequalities between socioeconomic classes Health outcomes  Self-reported health  Specific conditions  Mortality Utilization  Primary care practioner  Secondary care  Hospital admissions Introduction-Methods-Results-Discussion-Conclusion

4. Introduction Healthrisk  Unhealthy behaviour  Material circumstances  Childhood circumstances  Psychosocial factors Barriers patient’s side  Patient’s attitude  Lack of knowledge  health literacy  Lack of skills: coping, decision making and concordance Barriers provider’s side  Characteristics of healthcare system  Personal attributes of healthcare provider Lack of money Introduction-Methods-Results-Discussion-Conclusion

5. Introduction I n 1971 the death rate for adult men in social class V (unskilled workers) was nearly twice that of adult men in social class I (professional workers). People from low socio-economic classes experience barriers in healthcare after they develop an illness. P roblems originate in some adverse psychosocial factors: the patient’s attitude toward illness and towards the healthcare system and insufficient coping styles. This is closely linked to a lack of knowledge and health literacy which is more common among the poor and can lead to problems with the awareness of their own health condition, treatment options, diagnostic possibilities and recurrence.

6. To explore the accessibility of healthcare for poor people. The results can act as an guide for further studies about this subject needed for reformations in the primary healthcare Aim of the study Introduction-Methods-Results-Discussion-Conclusion

7. Methods: subjects and settings Ljubljana  fieldwork Qualitative method (the complex details about feelings, thoughts and social interactions) Ten participants selected by the district nurse and the GP Criteria:  Income below poverty line  Health problems Introduction-Methods-Results-Discussion-Conclusion

8. Methods: interviews Semi-structured Developed by literature review about health and income inequalities in the world Ten questions GP conducted the interviews at participant’s home Tape-recorderd, transcribed and translated to English Observation by the researcher Introduction-Methods-Results-Discussion-Conclusion

9. Methods: analysis Grounded theory from Glaser and Strauss Indepently coded by two researchers Validity control After third coding agreement was reached Introduction-Methods-Results-Discussion-Conclusion

10. Results Citizins of Ljubljana or near Ljubljana Caucasian Average age: 66,5 year (55-92) 6 males and 4 females Unemployed Introduction-Methods-Results-Discussion-Conclusion

11. Results Multimorbidity Mental State  Stress  Being captured  Family history  Loneliness (lack of social support)  “I often feel so lonely. I have no one who would talk to me or help me when I feel the most down.” (male, interview 9) Introduction-Methods-Results-Discussion-Conclusion

12. Results: accessibility problems Transportation:  Low mobility  No car  No driving license or driver  Difficulties to get on the bus  Poor access from and to home  Fear of walking  Not an appropiate way  “ I do not have enough money to buy a car adjusted to my needs.” (female, interview 1)  “ I cannot walk there, not with my feet.” (female, interview 6) Introduction-Methods-Results-Discussion-Conclusion

13. Results: accessibility problems Dependence  Other people:  Transportation  Medical supplies  Help with contact  Material:  Mean of transport  Portable oxygen bottle  Crutches, wheelchair  Insurance coverage  “The neighbours would help me call” (male, interview 3) Introduction-Methods-Results-Discussion-Conclusion

14. Barriers on patient’s side Lack of knowledgeLow education Attitude towards healthcare DissatisfactionGP Secondary care Health visitor Health system Atmosphere health centre Barriers on patient’s side Clinic for the homeless Emotions associated with healthcare Fear of doctors Shame Stubborn Reminder of bad times Dislike Caring for family membersBedridden husband

15. Barriers on the providers side Availability GP Absent at practice Long waiting time Low frequency of home visits Barriers on the provider’s side Problems to reach GP on the phone Little time, busy Absence of personal GP Specialist Absence Ambulance Waiting time Attitude Not taking patients serious

16. Results: solutions Self-management Another form of contact Another mean of transport: ambulance Another type of medical service Planning Help from others Introduction-Methods-Results-Discussion-Conclusion

17. Results: consequences Lower use of healthcare District nurse most important person in primary care Delay: late stage of disease  “The district nurse comes to see me every Thursday to control my blood sugar and pressure and to bring prescriptions and referral forms, if necessary. She is very kind to me and always asks me if I need anything else from the doctor.” (Male, interview 3) Introduction-Methods-Results-Discussion-Conclusion

18. Discussion Marital status, household composition and social support Multiple barriers Use of emergency service Insufficient engagement of GP Further research Limitations Introduction-Methods-Results-Discussion-Conclusion

19. Conclusion ProblemsBarriers on patient’s side Tranportation Dependence Barriers on provider’s side SolutionsSelf-management Other form of contact Accessibility Other way of transport Other medical service Planning Help from others ConsequencesLow utilization Important role of healthvisitor/district nurse Delay Introduction-Methods-Results-Discussion-Conclusion

20. Questions?