Equality in quality. Selected results from FRA Inequalities and multiple discrimination project in access to and quality of healthcare project

Transcription

1 Equality in quality Selected results from FRA Inequalities and multiple discrimination project in access to and quality of healthcare project Ludovica Banfi FUNDAMENTAL RIGHTS AGENCY (FRA) European Health Forum 4 October 2012 Hof Badgastein (Austria) 1

2 Background 1. European Commission proposal for an horizontal directive 2. Communication Solidarity in health The research To gain a better understanding of particular vulnerabilities resulting from the intersection of ethnic origin, disability, age and gender in access to healthcare and quality of care Coverage: 5 EU Member States: Austria, Czech Republic, Italy, Sweden and the UK Methodology: legal and social desk research; 300 qualitative semi-structured interviews (health users, professionals, advocacy groups, legal experts and policymakers) 2

3 EU anti-discrimination legislation European anti-discrimination legislation forbids discrimination in health on the grounds of race/ethnicity (Race Equality Directive, 2000) There is no provision in EU law that deals directly with multiple discrimination, but both the Employment Directive and the Racial Equality Directive explicitly acknowledge its existence in relation to women The European Commission issued in 2008 a proposal for a Council Directive on equal treatment to extend protection from discrimination on the grounds of age, disability, sexual orientation and religion or belief beyond the area of employment (so called Horizontal directive) including in the area of healthcare 3

4 Multiple discrimination can have different forms barriers in access to healthcare that in some cases may amount to indirect discrimination. The latter acknowledges that discrimination may result not only from treating people in similar situations differently, but also from offering the same treatment to people who are in different situations and have different needs perceived direct discrimination and/or multiple discrimination; 4

5 Barriers in access to healthcare unequal entitlements language and communication barriers financial barriers lack of information about healthcare entitlements and services organisational barriers and accessibility supply-side barriers cultural and psychological barriers 5

6 Unfair treatment and direct discrimination 1. delay of treatment 2. refusal of treatment 3. lack of dignity and stereotyping 4. malpractice and poor quality of care 5. lack of informed consent 6. harassment 6

7 Overview of available complaint mechanisms EUMS Patients/health complaint bodies Equality Bodies Internal (within the Heath Care system) External Single, covering all grounds of discrimination Many, covering various grounds of discrimination AT CZ IT SE x UK 7

8 Understanding under-reporting lack of knowledge about the complaints system lack of belief in the effectiveness of complaints and that complaints are not taken seriously fear of victimisation by healthcare staff after using the complaints mechanism; the complicated co-existence of separate complaint bodies lack of accessibility negative attitudes towards complaining among some ethnic communities time and effort needed for issuing a complaint 8

9 Barriers in access to justice Very few health users complain: those who do, are not satisfied with the outcome Lawyers frame cases using medical negligence or malpractice, rarely anti-discrimination legal framework compensation for non-pecuniary damages is generally very limited (even more so for discrimination cases), and compensation for medical maltreatment is much higher. it is often fairly easy for the defendants (doctors/hospitals) to prove that the unequal treatment was objectively justified) lack of awareness of discrimination among health complaint bodies and lack of referral mechanisms 9

10 EU law Providing equal protection against discrimination on the ground of religion or belief, disability, age and sexual orientation beyond employment as envisaged in the EU Commission proposal for a Horizontal directive-is the first step to take in the area of anti-discrimination law to combat discrimination in healthcare. 10

11 Institutionalising multi-dimensional equality in the healthcare system Member States should adopt measures to further the right to health on an equal basis: free linguistic assistance -including translation and mediation services for those who do not speak or understand the language and signed languages and other forms of support for people with sensory or intellectual impairments -should be made available in healthcare settings and when providing health information. Linguistic assistance is crucial in the context of informed consent (protected by article 3 of the Charter of Fundamental Rights); unequal treatment on the basis of language can easily result in indirect discrimination based on nationality (covered by the Transborder Healthcare Directive)and/or ethnicity (covered by the Racial Equality Directive). 11

12 Access to justice Member States should take the necessary steps to increase healthcare users awareness of the existence and functioning of the available complaint mechanisms, both for healthcare and discrimination issues. Referral mechanisms between these bodies should be enhanced. Complaint bodies should facilitate access to the complaint system for healthcare users who have specific linguistic needs and for those who have a disability. This can be done through the enhanced provision of information in different languages, including language accessible to persons with disabilities. 12

13 Thank you for your attention fra.europa.eu Contact: 13

14 Positive action EU Member States should encourage positiveactions for persons belonging to groups at risk of intersectional discrimination, as provided for by both the Racial Equality Directive and the Employment Equality Directive: the needs of women belonging to ethnic minorities who want to be treated by female healthcare professionals should be accommodated. A community-based mobile outreach program targeted toward different ethnic communities and groups among them - including elderly people, women and persons with different kind of disabilities -should be funded to promote healthcare and raise awareness of entitlements and available health services; more time should be allocated for medical consultations with persons belonging to these groups due to their special needs. 14

15 Improving data collection Addressing health inequalities requires the collection and use of disaggregated data on different equality grounds and their combination. There is a lack of reliable health statistics giving the full picture of the intersection of different grounds. In order to better reflect equality monitoring in EU cross-national surveys, data on ethnicity (recording both migrant status and ethnicity, where legal) and disability (that take into account the social model of disability ) should be included through national surveys that are carried out on a regular basis. In order to capture multiple inequalities and disadvantages, survey samples should be big enough to allow for further disaggregation. 15

16 Remedies Due to low compensation being awarded in discrimination cases, alleged victims of discrimination in healthcare often initiate other legal actions (e.g. tort actions on grounds of medical negligence). Compensation awarded in discrimination cases should be dissuasive and proportionate to the damage suffered, including in the area of healthcare. 16