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A Leap Forward for Millennials Changing the Future of Healthcare in Europe

A national & European approach


Methodology • National survey • • • •

sample type: nationally representative sample for the adult population of Romania sample design: quasi-random, multi-stratified sample sample size: 1,100 adults computer assisted telephone interviews (CATI), 814 interviews among mobile phone respondents, 286 interviews among landline respondents • sample margin of error for a 50% statistic with 95% confidence is +/- 2.95% for all adults • the database was not weighted • data collection: December 22, 2016 - January 6, 2017

• Qualitative research • 4 focus-groups: 3 in Bucharest, 1 in Pitesti • doctors, nurses, center-left / left voters (secondary education 50-64; higher education 22-34) • data collection: February, 2017

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Content • Health issues and healthcare in Romania • Trust in healthcare organizations • Best option for the healthcare system: public or private? • The European Union and healthcare • Youths on healthcare & EU • Ideological and political outlook

3


Health issues and healthcare in Romania


How satisfied are you with your health? 18-35

All respondents

24

Very satisfied

12

54

Fairly satisfied

53

17

Slightly dissatisfied

25

5

Very dissatisfied

%

9 0

10

20

30

40

50

60 5


Do you currently have any health issues? 18-35

All respondents

22

Yes, serious problems

39

34

Yes, but minor

38

44

No

%

23

0

10

20

30

40

50 6


Health problems and access to health services Yes Are you currently suffering of a chronic illness?

47

In the past 6 months, have you received any prescription for reimbursable medicine? In the past 6 months, have you received any medical advice from a specialist doctor?

No

53 66

34

61

In the past year, have you been hospitalized?

39

29

71

In the past year, have you had any relative or close acquaintance hospitalized?

52

In the past year, have you had any blood test done?

48 72

In the past year, have you had any medical investigation such as MRI or CAT scan?

28

42 0%

25%

58 50%

75%

100% 7


Do you smoke? Yes All respondents

No

22

78

18-35

30

70

35-49

29

71

50-64

65+

19

81

5 0%

95 25%

50%

75%

100% 8


Do you have a private healthcare insurance? Yes All respondents

No

12

18-35

88

18

82

35-49

11

89

50-64

10

90

65+

4 0%

96 25%

50%

75%

100% 9


Did you happen to need medical investigations or tests done in the public health system but you were unable to benefit from them because the laboratories were out of funds or available appointments? 18-35

All respondents

34

Yes

34

66

No

66 %

0

15

30

45

60

10


Has it happened for you to have health issues in the past year, but you were lacking the money to solve those? Yes All respondents

No

36

Urban

64

29

Rural

71 45

18-35

55

29

35-49

71

34

50-64

66 44

65+

56

40 0%

60 25%

50%

75%

100% 11


Satisfaction with patient care in public hospitals vs. age (Only for individuals that experienced hospitalization, themselves or relatives, close acquaintances) Very satisfied All respondents

Fairly satisfied

10

18-35

44

5

10

50-64

11

18

32

37

48 25%

25

33

54

16 0%

Very dissatisfied

28

38

35-49

65+

Slightly dissatisfied

50%

20

21

14

23

13

75%

100% 12


What is the most important problem of the public health system in Romania? (first choice) Group

First choice answer

1

insufficient funding, wages for medical staff incompetent “leadership” of the system staff motivation, top down insufficient medical staff, too few doctors overcrowding of hospitals; for any minor problem, patients do not go to family doctors but to emergency care in hospitals

2

wages (2) insufficient staff, lack of personnel (4) separation of public and private practice

3

overcrowding lack of investment in medical equipment, maintenance issues lack of personnel – doctors, nurses (2) lack of motivation bad maleagement

4

maleagement, bureaucracy, the way the budget is spent technology, infrastructure, lack of medical equipment waiting times doctors that co-operate with the state to maintain their positions (privileges)

13


What is the most important problem of the public health system in Romania? • “I was hospitalized with my sister, she had appendicitis. (…) Until I called my parents to come with money [for kickbacks] from home, they did not operate on her” (female, 25, student) • “I think the main problem of Romanian hospitals and the health system is that it has become a system for those with money; it is not a system for everyone anymore” (male, 30, employed) • “In the rural areas is terrible. There are maley places where there is no room [available] for a clinic [or doctor’s office]” (female, 27, employed) • “There are maley doctors that have private practices and are in the state system as well; the patient’s interest is disregarded in this case; on the contrary, patients are lured towards private practices” (male, 49, employed) 15


Agree or disagree? Agree

Fairly agree

Slightly disagree 96

Healthcare is a right, not a commodity Children’s vaccination against infectious disease is a necessity

4

91

If the health system is privatized, most people would not have enough money for healthcare

5 22

77

Cleanliness and disinfection are a problem in public hospitals

10 5 8

61

22

51

Patient care in public hospitals is lacking in quality

Romania’s medics are less prepared than they have used to be 10-20 years ago It is a good thing for a hospitalized person to offer gifts or rewards to the medical staff

Disagree

21 5 0%

13

16

29 22

16 25%

8

9

11

9

41 66

50%

75%

100% 16


Would you agree or disagree with an increase of the health budget, even though it would lead to an increase in taxation? 18-35

All respondents

86 I would agree 89

14 I would disagree 11

%

0

15

30

45

60

75

90 17


Trust in healthcare system organizations


How much do you trust the following? (all answers) A great deal

A fair amount

National Health Insurance House

Not very much

7

Private hospitals

38

11

6

Ministry of Health

4

27

Private healthcare insurers or companies

5

23

9

38

20

5

16

21

29

13 50%

9

41

31

28

25%

DK, NA

26

33

Public hospitals

0%

Not at all

5

12

42 75%

100% 19


How much do you trust the following? (valid answers) A great deal National Health Insurance House

Private hospitals

A fair amount

9

40

5

Public hospitals

6

Private healthcare insurers or companies

7 0%

22

32

33

55

40

16

32

42 25%

Not at all

28

30

20

Ministry of Health

Not very much

22

29 50%

9

22 75%

100% 20


What is the first thing that comes in your mind when you hear the words “public hospitals”? (focus groups) Group

Word, image association

1

crowding (3), maley patients, sick people (2), public institution – local community, squalor

2

health, too few personnel, public employees, squalor, lack of respect, deficient system, help for suffering patients

3

sick & hospitalized, fear & health in danger, poor, kickbacks & ailing people, good healthcare, stethoscope, not the same conditions as in private hospitals

4

kickbacks, squalor, lack of medicine; overcrowding, waiting, infections, less money; kickbacks, inefficiency, squalor; disaster, hospital disease, infections; career, life, passion, helping others; insufficient funds; kickbacks 21


What is the first thing that comes in your mind when you hear the words “private hospitals�? (focus groups) Group

Word, image association

1

high costs, inaccessible; not always justified; materially augmented personnel; comfort; luxury; business; new

2

luxury, other conditions compared to the state system; more safety, respect for patients and the other way around; spent money; on time, good conditions; decency; respect, cleanliness; a lot of money paid by patients for the same thing that is done in the state system

3

very good conditions; substantial payment; a lot of money, conditions; public money; advanced technology, good doctors; ostentatious consumption; qualified personnel, expertise, a lot of money

4

special treatment, modern, high-tech, frightened doctors; cleanliness; ok but some are focused only on image; career, efficiency; high prices; better conditions than the state system, attention, no kickbacks 22


With what type of car would you association the public healthcare system? Group 1

Dacia 1300 (3) Dacia Logan Tico vintage Aro 240 Hyundai Santa Fe older model

3

Dacia Logan (3) Skoda or Dacia Dacia 1300 Volkswagen Aro

4

Dacia 1300 (2), Dacia 1310 VW Trabant (2) Dacia Logan

23


With what type of car would you association the private healthcare system? Group 1

Honda, Alfa Romeo, Mercedes, Audi Q7, the new Hyundai Santa Fe, newest business sedan, higher end, expensive model

3

Mercedes (3), Bentley, Audi, Porsche, Ford

4

Bentley, BMW bought from Bulgaria, Toyota 4x4, Dacia Duster, Dacia Logan, Mercedes, VW Passat

24


With what type of drinks would you association the public healthcare system? Group 2

still water (3) sparkling water still water with bacteria and germs Pepsi plum brandy (tuica)

3

water acid sparkling water Dorna still water Oke milk wine (2) tea 25


With what type of drinks would you association the private healthcare system?

Group 2

still water (2) lemonade whisky sparkling wine vodka 100% natural juice

26


Best option for the healthcare system: public or private?


Which one of the following would you consider the best option for the healthcare system? Entirely public

Mainly public and secondary private

Mainly private and secondary public

Entirely private

All respondents

34

Urban

43

28

Rural

44

42

Subjective poverty

44

Subjective well-being

26 0%

15

19

50%

9

43

9

6

40

11

5

48 25%

8

17 75%

9 100% 28


Which one of the following would you consider the best option for the healthcare system? Entirely public Mainly private and secondary public All respondents

34

18-35

33

Higher education

43

66 25%

6

15

22 50%

11

20

43

Elementary education

8

17

55

34

0%

15

39

19

Secondary education

Mainly public and secondary private Entirely private

75%

8

5

7 100% 29


The health system: public or private? Re: mainly public, secondary private • “In terms of coverage, financial possibilities, living standards, I am talking about coverage for the entire population” (male, 52, doctor) • “The great majority of the population is very poor. For maley patients, going to the doctor is a luxury. A 50% or 20% reimbursed prescription counts a lot. It would be a tragedy. They would stay home until the last second, if it were private” (34, female, doctor)

30


The health system: public or private? Re: mainly public, secondary private • “Most of us could not afford private healthcare. Private for investigations, more than this we could not afford” (female, 51, employed) • “Because we live in Romania, people are poor, they do not have the money for private healthcare”

• “Most of us, the citizens of the country, are low income, so public first, compared to private” (female, 64, pensioner) • “Being left wing, I am for social insurance, health insurance, and for assisting the one that does not have 100 euro per day [for private]. So, if you go private, you have to pay any service, from opening the door to surgery. This is not the case in the public system, we paid insurance and I get the minimum [assistance]” • “First of all, every person should have access to healthcare, and than we should have a system that provides coverage, both financially [income wise] and throughout the country” 31


The European Union and healthcare


Have you received any medical treatment in another EU country in the past 12 months? 18-35

All respondents 95

No

95

2

Yes, a medical treatment that was not planned

2

3

Yes, a medical treatment that was planned

%

3

0

25

50

75

100 33


If you or a family member is given the situation of facing serious medical issues, would you be willing to travel to another EU country to receive medical treatment? 18-35

All respondents 47

Yes, I would

35

36

Yes, I would but I cannot afford it

43

17

No, I would not

%

22 0

10

20

30

40

50

34


For which of the following reasons, would you be willing to travel to another EU country to receive medical treatment? 18-35

All respondents 51 51

Better quality treatment

42 40

Treatment that is unavailable in Romania

5 5

Faster treatment

2

Other reason %

4

0

15

30

45 35


For which reasons, would you be willing to travel to another EU country to receive medical treatment? • “Now, after this experience [treatment in the EU], I would go for treatment only abroad; my great concern is that something should happen and I would need emergency care [in Romania]” (male, 31, employed) • “The facilities and medical equipment” (male, 33, employed) • “The services [are] much better; (…) I had a box of chocolates and wanted to give to a Germale nurse and she said that “it is the first time I received anything from anyone” (male, 31, employed) • “[they are] unaccustomed to give kickbacks, as it happens here” (female, 31, employed) 36


For which of the following reasons, you would NOT be willing to travel to another EU country to receive medical treatment? 18-35

All respondents 32

I cannot afford it

30 31

Treatment is available in Romania 13 13

I want to be close to home I do not have enough information regarding which treatments are available and their quality

10

Other reason

%

39

7

0

16

9

10

20

30

40 37


In different areas, the EU has different competences, with more or less power of decision. In the case of healthcare, it is up to national governments to organise healthcare and ensure it is provided.

Do you think the EU’s decision power regarding the healthcare system should be higher, lower or the way it is right now? 18-35

All respondents 54 54

Higher 5

Lower

10 15 14

The way it is right now

25

Don't know

21 1 1

NA %

0

15

30

45

60 38


Do you think the EU’s decision power regarding the healthcare system should be higher, lower or the way it is right now? • “Higher would be better” (female, 31, employed) • “Practically, this is why we are in the Union, to help each other and somehow [things] to be better off; clearly, Romania needs assistance” (female, 25, student) • “It think it would be better, since we joined to a common European system, already there is a [European] Parliament and so on… I think they could be more involved, meaning to allocate more funds, as we have a precarious health system” • “As it is now; in your kitchen nobody knows better” (female, 27, employed)

• “It’s normal to make our own calculations, not for them to come and tell us what to do, it remains for the [national] government”

39


What do you think: Romania’s EU accession is a good or a bad thing for our country? 18-35

All respondents 60

A good thing 57

10

A bad thing

13

21

Neither bad nor good

22

9

DK/NA

8 %

0

15

30

45

60 40


Romania & the EU: qualitative data • pro-EU position – – – –

open borders, free travel, especially compared to the Communist period employment in the EU, especially since jobs are lacking at home financial support from family members employed in the EU somewhat lacking enthusiasm

• Eurosceptic position – sovereign argument – economic argument: de-industrialization, lack of jobs linked with the EU – low absorption of post-accession funds leads to perception that there was no will for the EU to give support to a peripheral country • Romania’s EU membership is rather not regarded as an accomplishment, but rather as a given fact, something that would have happened anyway

41


How satisfied are you with the EU? 18-35

All respondents

5

Very satisfied

6 51

Fairly satisfied

47 19

Slightly dissatisfied

22 6

Very dissatisfied

10 19

NA %

15 0

15

30

45 42


Youths on healthcare & EU


Youths on healthcare • 3 out of 4 youths are satisfied with their health • Highest share of smokers than any other age group • Are more critical towards the public health system • 57% dissatisfied with care in public hospitals

• Have more trust towards private hospitals • Are more sensitive, critical towards informal payments (kickbacks) • Highest share of private healthcare insurance

44


Youths on the EU • 56% satisfied with the EU • 60% think Romania’s EU membership is a good thing • More open towards going for treatment in the EU • 54% think the EU should have more decision making power on health policies 45


Ideological and political outlook


Do you agree or disagree with the following statements? Rather agree

The state should spend more money for healthcare

The state creates more problems than it solves

The wage gap in Romania is too large

75%

Rather disagree

98

85

86

2

15

14

100% 47


Do you consider yourself being... 18-35

All respondents

6

A center-left person

10

6

A center-right person

8

26

A person interested in politics, but would not call myself neither a left or right leaning

30

62

A person with no interest in politics %

51 0

15

30

45

60 48


Favorable or unfavorable opinion on political parties Favorable PSD

Unfavorable

45

PNL

32

16

33

27

62

22 0%

27

40

10

PMP

23

57

ALDE

USR

No opinion

27

47 25%

31 50%

75%

100% 49


What does it mean to be a center-left person? (focus-group, center-left voters) • “I think the left is confused with Communism and the right with liberalism, entrepreneurs” (female, 31, employed) • “To support PSD” (female, 31, employed) • “More towards the social than the private, liberal side” (male, 31, employed)

• “To assist society more than business” (male, 31, employed) • “It means to have a political stance towards socialist” (female, 27, employed) • “Social protection” (female, 50-64, employed)

• “On the people’s side” (female, 50-64, employed) • “To be close to the people, to understand, to help them” (male, 59, pensioner) • “Do not think only about yourself, think also about those around you” (female, 64, pensioner) • “Concern for others” (male, 56, employed) 50


What does it mean to be a center-right person? • “You are more liberal (female, 25, student) • “Helps more the business side, the capitalist side (female, 27, employed) • “Deals more with development, modernization” (male, 30, employed) • “He who has, lives, he who has not, dies; law of the jungle” (male, 56, employed) • “They think more about themselves” (male, 59, pensioner) • “A person that puts into practice the principles of capitalism” (male, 64, pensioner) • “When I am concerned with my development and well-being, exclusively, (…) without caring that those around me are worse off; if I have surplus income, being right wing means investment for the improvement of my business, being left wing means giving this surplus to my neighbour that maybe did not ate that day” (female, 52, employed)

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A Leap Forward for Millennials Changing the Future of Healthcare in Europe A national & European approach

Changing the Future of Healthcare in Europe  

Study led by Fundația Stânga Democratică, the Foundation for European Progressive Studies and Friedrich-Ebert-Stiftung Romania >>> A Leap Fo...

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