Who wants to cross borders in the EU for health care?: an analysis of the Eurobarometer data in 2007 and 2014

ABSTRACT - BACKGROUND The EU Directive on cross-border healthcare clarified the entitlements of EU citizens to medical care in other EU Member states. However, little is known about whether EU citizens have been travelling or are willing to travel to receive medical care. The aim of this study was to measure the determinants of cross-border patient mobility and willingness to travel to receive medical care in the EU, before and after the adoption of the Directive. METHODS We used individual data from the Eurobarometer 210 (2007) and 425 (2014). In the two years, 54,384 EU citizens were randomly selected for telephone and face-to-face interviews. We performed a logistic regression on the cross-border patient mobility and willingness to travel to other EU countries to use healthcare services as a function of the year (2007 or 2014), adjusting for age, gender, education, self perceived health (SPH), and country size. RESULTS In 2007, 3.3% of citizens reported cross-border mobility, and 4.6% in 2014. The odds of cross-border patients’ mobility was 15% higher in 2014, compared to 2007 (OR 1.15, 95%CI 1.05-1.26, p<.001). In addition, mobility was 15% higher in males (OR 1.15, 95%CI 1.05-1.3, p<0.001) and 20% amongst the more educated (OR 1.2, 95%CI 1.1- 1.3, p<.001). However, the odds decreased with age (OR 0.9 per decade, 95%CI 0.84- 0.92, p<.001), bad and very bad SPH, and country size. In 2014 the willingness to travel decreased by 22% compared to 2007. The other determinants of willingness to travel, namely gender, age, education, SHP, and country size, had a similar effect as in the cross-border mobility model. CONCLUSIONS Cross-border patient mobility and willingness to travel are more likely amongst younger, more educated, and healthier patients from smaller countries. The 2011 directive does not seem to have promoted mobility at a large scale among the neediest citizens.RESUMO - INTRODUÇÃO A diretiva da União Europeia (UE) referente ao exercício dos direitos dos pacientes em cuidados de saúde transfronteiriços clarificou os direitos dos cidadãos da UE. No entanto, pouco se sabe sobre a mobilidade transfronteiriça dos pacientes e a vontade de viajar para receber cuidados médicos. Desse modo, pretendemos estudar os determinantes da mobilidade transfronteiriça dos pacientes e a vontade de viajar para receber cuidados médicos na UE, especialmente após a adoção da diretiva. MÉTODOS Utilizamos dados do Eurobarómetro 210 (2007) e 425 (2014). Nos dois anos 54.384 cidadãos da UE foram selecionados aleatoriamente para entrevistas telefónicas e pessoalmente. Aplicámos uma regressão logística à mobilidade transfronteiriça dos pacientes e a vontade de viajar para usar os serviços de saúde noutros países da EU em função do ano (2007 ou 2014), idade, sexo, educação, saúde auto-reportada e tamanho do país. RESULTADOS Em 2007, 3,3% dos cidadãos relataram mobilidade transfronteiriça aumentando para 4,6% em 2014. A probabilidade de mobilidade transfronteiriça dos pacientes foi 15% maior em 2014, em comparação com 2007 (OR 1,15, IC 95% 1,05-1,26, p <.001). Além disso, a mobilidade foi 15% maior em homens (OR 1,15, IC 95% 1,05-1,3, p <0,001) e 20% em níveis mais elevados de educação (OR 1,2, 95% CI 1.1-1,3, p <0,001). No entanto, a probabilidade diminuí com a idade (OR 0,9 por década, IC 95% 0,84-0,92, p <0,001), má e muito má saúde auto-reportada e tamanho do país. Por outro lado, em 2014, a vontade de viajar diminuiu 22% em relação a 2007. Os outros determinantes da vontade de viajar, sexo, idade, educação, saúde auto-reportada e tamanho do país tiveram um efeito semelhante ao do modelo da mobilidade. CONCLUSÕES Entre 2007 e 2014, houve um ligeiro aumento da mobilidade transfronteiriça dos pacientes, que é, no entanto ainda baixo. A mobilidade transfronteiriça dos pacientes e a vontade de viajar são mais prováveis entre os pacientes mais jovens, mais educados, mais saudáveis, e de países mais pequenos. A diretiva de 2011 não parece ter promovido a mobilidade em grande escala entre os cidadãos mais necessitados

An analysis of the Eurobarometer data in 2007 and 2014

Background: The European Union (EU) Directive on Patients' Rights in Cross-border Healthcare clarified the entitlements to medical care in other EU Member states. However, little is known about whether EU citizens have been travelling or are willing to travel to receive care. This study aimed to measure the determinants of cross-border patient mobility and willingness to travel to receive medical care in the EU, before and after the adoption of the Directive. Methods: We used individual data from the Eurobarometer 210 (2007) and 425 (2014). In the 2 years, 53 439 EU citizens were randomly selected. We performed a logistic regression on the cross-border patient mobility and willingness to travel to other EU countries to use healthcare services as a function of the year (2007 or 2014), adjusting for age, gender, education and country size. Results: In 2007, 3.3% of citizens reported cross-border mobility and 4.6% in 2014. The odds of cross-border patients' mobility were 11% higher in 2014, compared with 2007 [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.02-1.21]. Also, mobility was 19% higher in males (OR 1.19, 95% CI 1.08-1.30) and 20% higher amongst the more educated (OR 1.20, 95% CI 1.09-1.31). However, the odds decreased 11% per decade of age (OR 0.89 per decade, 95% CI 0.85-0.93) and country size. In 2014, the willingness to travel decreased by 20% compared with 2007. Conclusions: Cross-border patient mobility is more likely amongst the younger, the more educated and those from smaller countries. The directive does not seem to have promoted mobility at a large scale among the neediest citizens.publishersversionpublishe

A tale of two pandemics in three countries: Portugal, Spain, and Italy

This chapter explores the structural similarities and differences between these three countries: on the one hand, in their respective health sectors’ capacities and reorganization; and on the other hand, in the different degrees of state capacity to respond to the pressing needs of their populations. In the last great epidemic, the 1918 flu, there was a transparent north-south gradient in the extent to which European countries were hit by the pandemic, with Portugal, Spain, and Italy among those that were hit the hardest (Ansart et al., 2009). How was it this time? To what extent does the impact of COVID-19 reflect resilient societal and institutional vulnerabilities in these countries? And to what extent have national specificities interacted with those shared vulnerabilities, leading to different outcomes?info:eu-repo/semantics/publishedVersio

desafios para a saúde

publishersversionpublishe

interrupted time series analysis

publishersversionpublishe

a modelling study for Portugal

Funding Information: The authors acknowledge financial support from the Fundação para a Ciência e Tecnologia - FCT through project “Projection of the Impact of Non-pharmacological real-time Control and mitigation measures for the COVID-19 epidemic” (COVID-19 in-CTRL) - project n° 692 from the 2nd edition of RESEARCH 4 COVID-19. The first author also acknowledges FCT within the PhD grants program “DOCTORATES 4 COVID-19”, Grant No 2020.10172.BD. The second author also acknowledges FCT within projects UIDB/04621/2020 and UIDP/04621/2020. The third author also acknowledges FCT within the Strategic Project UIDB/00297 /2020 (Centro de Matemática e Aplicações, Universidade Nova de Lisboa ). Publisher Copyright: © 2022 The Author(s)Vaccination strategies to control COVID-19 have been ongoing worldwide since the end of 2020. Understanding their possible effect is key to prevent future disease spread. Using a modelling approach, this study intends to measure the impact of the COVID-19 Portuguese vaccination strategy on the effective reproduction number and explore three scenarios for vaccine effectiveness waning. Namely, the no-immunity-loss, 1-year and 3-years of immunity duration scenarios. We adapted an age-structured SEIR deterministic model and used Portuguese hospitalisation data for the model calibration. Results show that, although the Portuguese vaccination plan had a substantial impact in reducing overall transmission, it might not be sufficient to control disease spread. A significant vaccination coverage of those above 5 years old, a vaccine effectiveness against disease of at least 80% and softer non-pharmaceutical interventions (NPIs), such as mask usage and social distancing, would be necessary to control disease spread in the worst scenario considered. The immunity duration scenario of 1-year displays a resurgence of COVID-19 hospitalisations by the end of 2021, the same is observed in 3-year scenario although with a lower magnitude. The no-immunity-loss scenario presents a low increase in hospitalisations. In both the 1-year and 3-year scenarios, a vaccination boost of those above 65 years old would result in a 53% and 38% peak reduction of non-ICU hospitalisations, respectively. These results suggest that NPIs should not be fully phased-out but instead be combined with a fast booster vaccination strategy to reduce healthcare burden.publishersversionpublishe

risk factors associated with road traffic injuries in Mozambique: results of the 2016 INCOMAS study

publishersversionpublishe

sensitivity analysis

publishersversionpublishe

Comparative complete scheme and booster effectiveness of COVID‐19 vaccines in preventing SARS‐CoV‐2 infections with SARS‐CoV‐2 Omicron (BA.1) and Delta (B.1.617.2) variants: A case–case study based on electronic health records

Background: Information on vaccine effectiveness in a context of novel variants of concern (VOC) emergence is of key importance to inform public health policies. This study aimed to estimate a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.617.2 and sub-lineages) VOC according to vaccination exposure (primary or booster). Methods: We developed a case-case study using data on RT-PCR SARS-CoV-2-positive cases notified in Portugal during Weeks 49-51, 2021. To obtain measure of comparative vaccine effectiveness, we compared the odds of vaccination in Omicron cases versus Delta using logistic regression adjusted for age group, sex, region, week of diagnosis, and laboratory of origin. Results: Higher odds of vaccination were observed in cases infected by Omicron VOC compared with Delta VOC cases for both complete primary vaccination (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.8 to 2.4) and booster dose (OR = 5.2; 95% CI: 3.1 to 8.8), equivalent to reduction of vaccine effectiveness from 44.7% and 92.8%, observed against infection with Delta, to -6.0% (95% CI: 29.2% to 12.7%) and 62.7% (95% CI: 35.7% to 77.9%), observed against infection with Omicron, for complete primary vaccination and booster dose, respectively. Conclusion: Consistent reduction in vaccine-induced protection against infection with Omicron was observed. Complete primary vaccination may not be protective against SARS-CoV-2 infection in regions where Omicron variant is dominant.The acquisition of sequencing equipment and reagents used in this study by the Instituto Nacional de Saúde Doutor Ricardo Jorge was partially funded by the HERA project (grant no. 2021/PHF/23776), supported by the European Commission through the European Centre for Disease Control, and also partially funded by the Genome PT project (grant no. POCI-01-0145-FEDER-022184), supported by COMPETE 2020–Operational Programme for Competitiveness and Internationalisation, Lisboa Portugal Regional Operational Programme, Algarve Portugal Regional Operational, under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund, and by the Portuguese Science and Technology Foundation. The Algarve Biomedical Center Laboratory received public funding through the Project ALG-D2-2021-06 Variants Screen in Southern Portugal–Monitoring Variants of Concern in Southern Portugal and the Portuguese Science and Technology Foundation national support through the Comprehensive Health Research Center (grant no. UIDP/04923/2020).info:eu-repo/semantics/publishedVersio

LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol

Study ProtocolApproximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC’s burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The “Cardiovascular and respiratory events following COVID-19” component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The “Physical and mental symptoms following COVID-19” component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.This study is sponsored by Pfizer (grant code #68639655).info:eu-repo/semantics/publishedVersio