5.8 Support from health insurers and health authorities

From the limited information we have identified, health insurers and national health authorities rarely offer support with adjusting to life after stroke beyond, in some cases, loans for home adaptations and aids, and financial benefits for those eligible for reasons of unemployment, sickness or disability.

Formal care services are funded less in central Europe (e.g. Austria, Germany, Netherlands, France, Belgium, Czech Republic, and Poland) and southern Europe (e.g. Spain, Italy and Greece), compared with northern Europe (e.g. Denmark, Ireland and Sweden)[7].

Independent living support for disabled people (as a result of stroke or other causes) is very wide-ranging across Europe. There has been more focus on institutional care in some of the newer EU states (e.g. Bulgaria, Lithuania, Romania, Slovenia[325]). Access to support can be complicated by disagreements between health and social care bodies over which department is responsible for providing rehabilitation, aids and so on (e.g. Sweden[327]).

There is some evidence that austerity has had an impact on funding of services and financial support for disabled people, which potentially includes stroke survivors and their families[328]. Most European countries have cut funding to health care, social care and/or to non-governmental organisations in the last 5-10 years, with growing inequality between rural and urban areas in access to services.

The areas that have been negatively affected vary between countries but include: vocational rehabilitation and training and support for employers of people with disabilities; access to personal budgets; disability benefits; and help with costs e.g. transport[328].

Some countries (Bulgaria, Greece, Poland, Romania) have abandoned programmes such as plans to move care more into the community. Some countries (Bulgaria, Greece, Italy, Hungary, Spain, Portugal and Romania) have re-emphasised that the family has the main (social) caring responsibility, before the state. Some have introduced or increased user fees for health services or medications (Hungary, Estonia, Portugal, Spain, UK), and made the criteria for accessing disability benefits or personal assistance more strict (Greece, Hungary, Ireland, Italy, Portugal, Slovenia, Slovakia, Spain, Sweden, UK)[328].

There are some examples of follow-up support being funded. Social insurance institutions in Estonia and Finland offer vocationally oriented  rehabilitation; the Estonian scheme also offers peer support[9, 329]. In parts of the UK the Stroke Association is commissioned to provide ‘Life after Stroke’ services, including practical (communication support, return to work etc.) and emotional support.

“The challenges [for stroke survivors and families in Greece] are day to day living …. But also, it is becoming a viable member of society again and I think that’s important worldwide, not only in [my country] Greece. In Greece you do have support, but you do have the immediate consequences of stroke which are quite devastating for everybody.”
(Stroke clinician and stroke support organisation volunteer, Greece)