Can people afford to pay for health care? New evidence on financial protection in Europe
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World Health Organization. Regional Office for Europe
Abstract
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xx, 119 p.
Out-of-pocket payments for health can create a financial barrier toaccess, resulting in unmet need, or lead to financial hardship for peopleusing health services. This report brings together for the first time dataon unmet need and financial hardship to assess whether people living inEurope can afford to pay for health care. Drawing on contributions fromnational experts in 24 countries, the report shows that financial hardshipvaries widely in Europe, and that there is room for improvement even inhigh-income countries that provide the whole population with access topublicly financed health services. Catastrophic health spending is heavilyconcentrated among the poorest households in all of the countries in thestudy. Where financial protection is relatively weak, catastrophic spendingis mainly driven by out-of-pocket payments for outpatient medicines. Health systems with strong financial protection and low levels of unmetneed share the following features: there are no large gaps in healthcoverage; coverage policy – the way in which coverage is designed,implemented and governed – is carefully designed to minimize accessbarriers and out-of-pocket payments, particularly for poor people andregular users of health services; public spending on health is high enough toensure relatively timely access to a broad range of health services withoutinformal payments; and as a result, out-of-pocket payments are low, accounting for less than or close to 15% of current spending on health. Gaps in coverage arise from weaknesses in the design of three policyareas: population entitlement, the benefits package and user charges (copayments). The report summarizes actions that can reduce unmet needand financial hardship by strengthening coverage policy. It also highlightsactions that should be avoided.
Out-of-pocket payments for health can create a financial barrier toaccess, resulting in unmet need, or lead to financial hardship for peopleusing health services. This report brings together for the first time dataon unmet need and financial hardship to assess whether people living inEurope can afford to pay for health care. Drawing on contributions fromnational experts in 24 countries, the report shows that financial hardshipvaries widely in Europe, and that there is room for improvement even inhigh-income countries that provide the whole population with access topublicly financed health services. Catastrophic health spending is heavilyconcentrated among the poorest households in all of the countries in thestudy. Where financial protection is relatively weak, catastrophic spendingis mainly driven by out-of-pocket payments for outpatient medicines. Health systems with strong financial protection and low levels of unmetneed share the following features: there are no large gaps in healthcoverage; coverage policy – the way in which coverage is designed,implemented and governed – is carefully designed to minimize accessbarriers and out-of-pocket payments, particularly for poor people andregular users of health services; public spending on health is high enough toensure relatively timely access to a broad range of health services withoutinformal payments; and as a result, out-of-pocket payments are low, accounting for less than or close to 15% of current spending on health. Gaps in coverage arise from weaknesses in the design of three policyareas: population entitlement, the benefits package and user charges (copayments). The report summarizes actions that can reduce unmet needand financial hardship by strengthening coverage policy. It also highlightsactions that should be avoided.