ACCESS TO HEALTHCARE AND LONG-TERM CARE Equal for women and men? European Commission This publication is supported under the European Community programme for employment and social solidarity (2007–13) (Progress). This programme is managed by the Directorate-General for Employment, Social Affairs and Equal Opportunities of the European Commission. It was established to financially support the implementation of the objectives of the European Union in the employment and social affairs area, as set out in the social agenda, and thereby contribute to the achievement of the Lisbon strategy goals in these fields. The seven-year programme targets all stakeholders who can help shape the development of appropriate and effective employment and social legislation and policies, across the EU-27, EFTA–EEA and EU candidate and pre-candidate countries. The mission of Progress is to strengthen the EU contribution in support of Member States’ commitments and efforts to create more and better jobs and to build a more cohesive society. To that effect, progress will be instrumental in: — providing analysis and policy advice on Progress policy areas; — monitoring and reporting on the implementation of EU legislation and policies in Progress policy areas; — promoting policy transfer, learning and support among Member States on EU objectives and priorities; and — relaying the views of the stakeholders and society at large. For more information see: http://ec.europa.eu/progress ACCESS TO HEALTHCARE AND LONG-TERM CARE: Equal for women and men? Final Synthesis Report EGGSI coordinating team Chiara Crepaldi, Manuela Samek Lodovici, Marcella Corsi In collaboration with: Stefano Capri, Sandra Naaf, Sergio Pasquinelli Expert Group on Gender Equality and Social Inclusion, Health and Long-Term Care Issues (EGGSI) (* indicates non-EU countries) Bettina Haidinger (Austria) Ilze Trapenciere (Latvia) Nathalie Wuiame (Belgium) Ulrike Papouschek (Liechtenstein)* Maria Slaveva Prohaska (Bulgaria) Ruta Braziene (Lithuania) Susana Pavlou (Cyprus) Frances Camillieri-Cassar (Malta) Alena Křížková (Czech Republic) Hugo Swinnen (Netherlands) Bent Greve (Denmark) Ira Malmberg-Heimonen (Norway)* Reelika Leetmaa and Marre Karu (Estonia) Irena Topinska (Poland) Anita Haataja (Finland) Teresa Maria Sarmento Pereira (Portugal) Anne Eydoux (France) Marieta Radu (Romania) Alexandra Scheele and Julia Lepperhoff (Germany) Eva Havelková (Slovakia) Maria Stratigaki (Greece) Masa Filipović (Slovenia) Beáta Nagy (Hungary) Elvira González Gago (Spain) Sigurbjörg Sigurgeirsdóttir (Iceland)* Anita Nyberg (Sweden) James Wickham (Ireland) Claire Annesley (United Kingdom) Flavia Pesce (Italy) European Commission Directorate-General for Employment, Social Affairs and Equal Opportunities Unit G.1 Manuscript completed in October 2009 This report was financed by and prepared for the use of the European Commission, Directorate-General for Employment, Social Affairs and Equal Opportunities in the framework of a contract managed by the Istituto per la Ricerca Sociale and Fondazione Giacomo Brodolini. It does not necessarily reflect the opinion or position of the European Commission, Directorate-General for Employment, Social Affairs and Equal Opportunities. IRS- Istituto per la Ricerca Sociale Fondazione Brodolini Via XX Settembre 24 Viale di Villa Massimo 21 20123 Milan MI 00161 Rome RM ITALY ITALY +39 2467641 +39 44249625 [email protected] [email protected] www.irs-online.it http://www.fondazionebrodolini.it/ Cover photo: © 123RF For any use or reproduction of photos which are not under European Communities copyright, permission must be sought directly from the copyright holder(s). Europe Direct is a service to help you find answers to your questions about the European Union Freephone number (*): 00 800 6 7 8 9 10 11 (*) Certain mobile telephone operators do not allow access to 00 800 numbers or these calls may be billed. More information on the European Union is available on the Internet (http://europa.eu). Cataloguing data as well as an abstract can be found at the end of this publication. Luxembourg: Publications Office of the European Union, 2009 ISBN 978-92-79-14854-5 doi:10.2767/93670 © European Union, 2010 Reproduction is authorised provided the source is acknowledged. Printed in Belgium PRINTED ON WHITE CHLORINE -FREE P A P ER Contents Executive summary ..................................................................................................... 5 Zusammenfassung ....................................................................................................11 Résumé ..........................................................................................................................17 Introduction .................................................................................................................23 1. Main characteristics and recent trends in the health status of women and men ........................................................................................... 25 1.1. Gender differences in life expectancy and healthy life years .............................................................25 1.2. Self-perceived health and disability ............................................................................................................25 1.3. Gender differences in health risks and death by typology of diseases .........................................28 1.4. Gender differences in mortality rates .........................................................................................................32 1.5. The impact of income and social inequalities on gender differences in health status .............35 2. Gender differences in access to healthcare .........................................41 2.1. Existing service provisions: an overview of gender differences .......................................................41 2.1.1. Health promotion ........................................................................................................................................................ 43 2.1.2. Health prevention ........................................................................................................................................................ 50 2.1.3. General treatment ........................................................................................................................................................ 67 2.1.4. Gender mainstreaming in healthcare: recent trends ............................................................................. 84 2.2. Barriers to accessing service provisions .....................................................................................................87 2.2.1. Financial barriers: insurance coverage and individual costs .............................................................. 89 2.2.2. Cultural barriers ...........................................................................................................................................................100 2.2.3. Geographical and physical barriers .................................................................................................................106 3. Gender differences in access to long-term care (LTC) ................... 111 3.1. Overview of existing LTC service provisions ..........................................................................................111 3.2. Overview of existing service provisions for LTC from a gender perspective ..............................115 3.3. Gender barriers to access LTC ......................................................................................................................118 3.3.1. Gender and financial barriers ..............................................................................................................................118 3.3.2. Gender and geographical barriers ...................................................................................................................119 3.3.3. Gender and bureaucratic and administrative barriers ........................................................................120 3.3.4. Gender and cultural barriers ................................................................................................................................120 3.4. Programmes aimed at overcoming barriers to LTC ..............................................................................122 3.5. Overall conclusions about gender barriers to access LTC ..................................................................124 4. Conclusions ................................................................................................... 125 5. Annex – Statistical tables .......................................................................... 129 References .................................................................................................................. 133 3 Executive summary While healthcare systems have contributed to diseases, such as for cardiovascular and many sexually significant improvements in health in Europe, access to transmitted diseases. healthcare remains uneven across countries and social groups, according to socioeconomic status, place of Besides biological factors, social norms also affect the residence, ethnic group, and gender. health status of women and men differently: women are less likely to engage in risky health behaviour and Gender plays a specific role both in the incidence and consequently face fewer of the related illnesses and prevalence of specific