Accessibility of the health care services to Lithuanian residents in rural and urban areas

Šio straipsnio tikslas – išanalizuoti prieinamumo prie ambulatoriniu sveikatos priežiuros paslaugu kliutis ir konteksta per kaimo bei miesto gyventoju patirtis Lietuvoje. Tyrimo metodas – pusiau strukturuoti kokybiniai interviu. Interviu atlikti 2010 m. rugsejo–lapkricio menesiais. Iš viso atlikta 68 interviu, iš kuriu 29 – su kaime gyvenanciais respondentais, 39 – su gyvenanciais miestuose ir miesteliuose. Respondentu sudetis – 20 vyru, 48 moterys. Amžiaus vidurkis – 52 metai. Remiantis kokybiniu ir kiekybiniu turinio analizes metodais, išskirtos ir kiekybiškai apibendrintos finansinio, komunikacinio / teritorinio ir organizacinio prieinamumo kliutys. Kiekybiniu apibendrinimu kontekstas iliustruotas kokybiniais pavyzdžiais. Brangus nekompensuojami ar iš dalies kompensuojami vaistai, brangios mokamos paslaugos, ypac odontologu ir medicininiu tyrimu, – praktiškai neiveikiamos finansines kliutys mažas pajamas turintiems asmenims: jiems tenka arba išleisti santaupas, arba apriboti kitus bazinius poreikius. Kaime gyvenantiems asmenims papildomai prisideda keliones išlaidos, kurios jiems – didele našta, susijusi ir su teritorinemis kliutimis. Tai viešojo transporto problemos: viešojo transporto prieinamumas, maršrutai, tvarkarašciai, dideli atstumai iki sveikatos priežiuros istaigu. Be neformalios pagalbos daugumai tyrime dalyvavusiu kaimo gyventoju sveikatos priežiura taptu labai sunkiai arba visiškai neprieinama. Žvelgiant i prieinamumo kliutis, kurios atsiranda del sveikatos priežiuras teikianciu instituciju administraciniu-organizaciniu charakteristiku, nustatyta: pacientams tenka iveikti ilgas eiles, kurios susidaro del nepatogaus (per trumpo) darbo laiko, talonelyje nurodyto laiko nesilaikymo.[...]The article analyzes the accessibility of the health care services and identifies major barriers to them that the Lithuanian residents encounter in rural and urban areas. It is based on 68 semi-structured interviews conducted in September – November of 2010. 29 of the respondents lived in the countryside and 39, in the cities and smaller towns. 20 males and 48 females were interviewed. The average age of the respondents was 52 years. The qualitative and quantitative content analysis methods helped to identify financial, physical and organizational barriers to the access to the health care services. The main economic barriers to the health care services in Lithuania are expensive, partially compensated or not compensated drugs, paid services and examinations. Dental care and expensive medical tests was a particularly important barrier for the lowincome individuals. Lithuanians living in the rural areas face territorial barriers, such as additional travel costs, problematic and inconvenient routes and schedules of the public transport, and very long distances to the health care centers. It should be emphasized that without the informal support most health care services would become very complicated or even completely inaccessible for the rural residents. Finally, patients are facing long queues at the reception desks, the health care professionals’ inconvenient working hours and the medical personnel’s unethical behavior. In addition, the analysis of the health care access also demonstrates that there exists a lack of medical professionals and of objective information about the state-funded services and essential drugs in the rural areas. These factors make patients pay bribes to the doctors. It is evident that financial, organizational and physical barriers to the access of the health care are more relevant to residents with low income in the rural areas than those in the Lithuanian cities.[...]Politikos mokslų ir diplomatijos fakult.Viešojo administravimo katedraVytauto Didžiojo universiteta