Background: Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief.Method and materials: For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019.Results: Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law.Discussion: The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations.Conclusions: Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.

Background: The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia.Methods: We conducted a search for documents in national legal databases and reviewed legal commentaries, scientific literature and official reports of equality bodies. We integrated a comparative method with text analysis and the critical interpretive approach. The documents were examined in their original languages: Croatian, German, Polish, and Slovenian.Results: All examined states prohibit discrimination and guarantee the right to healthcare on the constitutional level. However, there are significant differences among them on the statutory level, regarding both anti-discriminatory legal measures and other legislation affecting access to healthcare for groups of diverse race or ethnicity, religion or belief, sexual orientation or gender identity. Croatia and Slovenia show the most comprehensive legislation concerning non-discrimination in healthcare in comparison to Germany and even more Poland. Except for Slovenia, explicit provisions protecting equal access for members of the abovementioned groups are insufficiently represented in healthcare legislation.Conclusions: The study identified legislative barriers to access to healthcare for persons of diverse race or ethnicity, religion or belief, sexual orientation or gender identity in Croatia, Germany, Poland and Slovenia. The discrepancies in the level of implementation of anti-discriminatory measures among these states show that there is a need for comprehensive EU-wide regulations, which would implement the principle of equal treatment in the specific context of healthcare. General anti-discrimination regulations should be strengthened by inclusion of anti-discrimination provisions directly into national legislation relating specifically to the area of healthcare.

Diversity competency is an approach for improving access to healthcare for members of minority groups. It includes a commitment to institutional policies and practices aimed at the improvement of the relationship between patients and healthcare professionals. The aim of this research is to investigate whether and how such a commitment is included in internal documents of hospitals in Croatia, Germany, Poland, and Slovenia. Using the methods of documentary research and thematic analysis we examined internal documents received from hospitals in these countries. In all four countries, the documents concentrate on general statements prohibiting discrimination with regard to healthcare provision. Specific regulations concerning ethnicity and culture focus on the issue of language barriers. With regard to religious practices, the documents from Croatia, Poland, and Slovenia focus on dominant religious groups. Observance of other religious practices and customs is rarely addressed. Healthcare needs of patients with non-heteronormative sexual orientation, intersexual, and transgender patients are explicitly addressed in only a few internal documents. Diversity competency policies are not comprehensively implemented in hospital internal regulations in hospitals under investigation. There is a need for the development and implementation of comprehensive policies in hospitals aiming at the specific needs of minority groups.

The aim of this paper is to critically analyze the account of peripheral philosophy that goes by the name of “the geospatial model” and to propose an alternative account that I call “the knowledge circulation model.” I examine three forms of the geospatial model as developed by three thinkers; the Polish philosopher Eugeniusz Górski’s concept of peripheral thought; the Chilean philosopher Eduardo Devés Valdés, who took up and elaborated on Górski’s concept; and the Argentine philosopher Walter D. Mignolo, who developed a concept of the decoloniality of knowledge. I argue that “the geospatial model” detaches the concept of peripherality from its actual material determination and locates it exclusively in the ideological sphere, thus marking a break with Marxism, dependency theory, and world-systems theory. This leads either to the stereotyping, culturalization, or essentialization of non-Western philosophical production, as well as to a potential ideological function that would see it legitimize the oppressive and imperialist goals of non-Western political powers. Finally, I propose a preliminary definition of the knowledge circulation model of peripheral philosophy as philosophy that is “situated on the outskirts of the global circulation of philosophical production.” This approach retains the decolonial potential but avoids the difficulties associated with the geospatial model.

W artykule prześledzono przemiany rozumienia sprawiedliwości w zdrowiu od utożsamiania jej ze sprawiedliwą dystrybucją opieki zdrowotnej do koncepcji sprawiedliwości zdrowotnej. Nakreślono koncepcję sprawiedliwego dostępu do opieki zdrowotnej, wskazując na trudności, które napotyka realizacja tej koncepcji w warunkach utowarowienia opieki zdrowotnej. Omówiono znaczenie, jakie dla przemian w myśleniu o sprawiedliwości w zdrowiu miało pojawienie się koncepcji społecznych determinant zdrowia oraz pojęcia gradientu społecznego w zdrowiu. Wskazano na teoretyczne ugruntowanie tych koncepcji w podejściu zdolnościowym, w którym zdrowiu przypisuje się wartość wewnętrzną i uznaje się je za nieodzowny składnik pełnego rozkwitu człowieka. Rozważono ograniczony charakter recepcji koncepcji społecznych determinant zdrowia i gradientu społecznego w dokumentach z zakresu polityki zdrowotnej.