Dear Mr Vardakastanis,
We thank you for your letter of 6 April 2020 expressing your concerns about the discrimination of persons with disabilities and the barriers in access to healthcare experienced during the pandemic.
The coronavirus crisis has put an unprecedented strain on the capacity of the Member States’ healthcare systems. Persons with disabilities and elderly people in residential care have been particularly exposed during the crisis and their continued access to medical and social care, including emergency and intensive care services have in some instances proved problematic. This reveals the weaknesses in the capacities of healthcare and social services systems to provide integrated care during times of crisis.
The coronavirus pandemic has clearly shown that we need to reach the most vulnerable and to ensure that no one is left behind because of disability or age. Social isolation measures and the risk of infection for both care professionals and persons with disabilities, together with the limited availability of protective material, created additional challenges.
The organisation and delivery of health services and medical care and the organisation of health insurance systems is a national competence. However, the European Pillar of Social Rights affirms everyone’s right to timely access to affordable, preventive and curative health care of good quality.
The EU Charter of Fundamental Rights also enshrines people’s right of access to treatment and care and Sustainable Development Goals reaffirm the commitment to ensure universal healthcare coverage. The announcement in January this year of a forthcoming clear and precise Action Plan of Implementation of the European Social Rights is an opportunity to strengthen the response to needs and ensure that nobody is left behind.
Furthermore, all Member States and the EU are party to the UN Convention on the Rights of Persons with disabilities, which recognises that persons with disabilities have the right to the
enjoyment of the highest attainable standard of health without discrimination on the basis of disability. In particular, the Convention stipulates that persons with disabilities should be
provided with the same range, quality and standard of free or affordable health care and programmes as provided to other persons. In addition, in accordance with Article 15 of the
UNCRPD, no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his or her free consent to medical or
scientific experimentation. To that end, accessibility of information and communication must be guaranteed for persons with disabilities.
To capture better the inequalities in access to healthcare, the Commission started to improve the measurement framework for access to healthcare along the lines explained in the 2019 State of
Health in the EU Report3. The Report showed that foregone medical care needs come across three dimensions of healthcare coverage: depth – the range of services available, height – the
proportion of the total cost covered by insurance and breadth – the proportion of the population that is covered and these gaps are not necessarily captured through available indicators.
Based on this report, we have undertaken work with the Member States in the framework of the Social Protection Committee and Healthcare Systems Performance Assessment experts group. The
objective is to develop tools to better understand what drives gaps in access to healthcare and support clearer signposting to the policies and approaches that will produce more equity in health
results through more targeted measures. While the report does not address the issue of accessibility for persons with disabilities, the background work showed that it is essential to
remove inequalities in access to healthcare for people with disabilities.
Furthermore, in view of fostering greater access to healthcare, we encourage the Member States to address country-specific challenges in access of healthcare systems within the European
Semester. Problems with access, including low levels investments in healthcare, gaps in population coverage, high costs co-sharing requirements, shortages of healthcare professionals,
territorial disparities in access to healthcare, and need to reshape the service delivery to make it more responsive to healthcare needs, are systematically analysed in Country Reports. In our
country-specific recommendations, we urged the Member States to take measures to alleviate critical barriers in access to healthcare and to improve effectiveness and sustainability of
healthcare systems. Accessibility is also an obligation for public sector websites in accordance with the Web Accessibility Directive. The Commission Recommendation related to mobile apps
in the context of coronavirus crisis also refers to accessibility.
Health systems are evolving towards more health promotion and disease prevention, shifting away from hospital and institution-centred care to community – or home-based care, towards
integration of health and social care. These changes require different infrastructure investments in primary and community care facilities or more “soft” investments such as prevention
programmes, integrated care and workforce training, for which EU funding will be instrumental.
Although to transform their health systems, Member States and regions need to design long-term investment strategies taking into account all the necessary elements. EU funding can, and should, contribute to all part of such investment strategies in combination with other instruments such as the InvestEU programme or national programmes.