Equal Access to Care: Challenges for Vulnerable Groups Highlighted by Integrated Care Agreement (IZA)

The Integrated Care Agreement (IZA) emphasizes equal access to care, with particular attention to vulnerable groups

To reduce the growing pressure on the Dutch health care system, more emphasis is placed on the personal responsibility of people with long-term care needs for their health, care and support. However, experiences from the corona pandemic show that not everyone is able or willing to do this. For example, care appointments were canceled much more often during the pandemic for people with chronic illness and limited health literacy than for those with sufficient health literacy. Postponing caregiving roles also caused people with a chronic illness or disability to make more frequent changes in their self-management behaviour. Many people with chronic illness also report that they are unwilling or unable to take an active role in their own care. This is evident from research by Nivel on health literacy, self-management and self-management of different groups of healthcare users.

The Integrated Care Agreement (IZA) emphasizes equal access to care, with particular attention to vulnerable groups. The government is increasingly focusing on the principle of autonomy and self-reliance. People are initially encouraged to work independently with the support of their informal network, before contacting professional care providers. However, research by Nivel shows that one in four Dutch adults have insufficient or limited health skills. In addition, there is a large group of people who have long-term care needs. What are they up against? What are their experiences, ideas and aspirations? How can they access care now that more demands are being placed on their own resources? With the help of the Nivel panels, we give these people a voice and thus clarify their perspective. Would you like to discuss how we can use this insight to reduce unequal access to care? Then register for our Nivel-connects session Ideas on Access on May 23rd!

Corona pandemic highlights differences in access to care by health literacy
Research by Nivel among people with chronic illnesses, such as diabetes, cardiovascular disease or lung disease, showed that they had problems with access to care during the corona pandemic. There was a clear difference between people with a chronic illness with limited health literacy and with sufficient health literacy. Almost 40% of those with limited health literacy reported that they have canceled health care appointments. Among those with sufficient health literacy, this percentage was significantly lower, at only 23%. This indicates that the likelihood of adverse health effects when access to care is reduced, such as during a pandemic, is greater for people with limited health literacy.

Managing your own health, care or support is not obvious to everyone
Not everyone is able to function independently before calling in professional caregivers. People who require long-term care or support, especially those with moderate or severe physical disability, young adults and people with limited educational background, generally show a lower level of self-management skills . Additionally, self-management behaviors appear to be related to access to care and continuity of health care providers. During the corona pandemic, people whose care was suspended or canceled more often reported that they made changes in their self-management behavior than people who had no problem accessing the they care.

Almost 40% of people with a chronic illness cannot or have not taken an active role in their own care
People with long-term care needs place a high value on being in control of their health and well-being. However, the extent to which they succeed in this varies greatly from person to person. Around 37% of people with a chronic illness indicate that they do not have the necessary knowledge, skills or motivation to actively contribute to their own health and care. This is especially true for the elderly, people with a lower level of education and those who have more severe physical complaints as a result of the illness. Our research among people with lung disease shows that these vulnerable groups often do not feel that they can control their treatment with their healthcare providers. In addition, some people prefer to leave their decisions to the health care provider.

Source: Level

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