What happens when people have to pay out of pocket for health services? The WHO promotes reflection on this question, particularly on World Health Day (7 April). With the recent publication of the report, ‘Can people afford to pay for health care? New evidence on financial protection in Europe’, the WHO offers new evidence that some people face economic barriers to access to medical treatment, with the consequent impacts on their health.
Prepared by WHO’s Barcelona Office for Health Systems Strengthening at Sant Pau, the new study draws on contributions from national experts in 24 countries, revealing that:
– between 1% and 9% of households in Europe are pushed into poverty – or further into poverty – after out-of-pocket payments;
– between 1% and 17% of households experience catastrophic health spending, which may mean they can no longer afford to meet other basic needs like food, housing and heating;
– catastrophic health spending is consistently concentrated among the poorest 20% of the population; and
– it is mainly driven by out-of-pocket payments for outpatient medicines.
The report brings together for the first time data on financial hardship and unmet need.
Out-of-pocket payments undermine country progress towards universal health coverage
Ensuring everyone can use quality health services without experiencing financial hardship is a Sustainable Development Goal all countries have committed to reach by 2030, and a priority for WHO.
“One of the report’s most valuable features is that it goes beyond numbers to explore the policies responsible for stronger or weaker financial protection at country level, allowing us to draw conclusions about how to make progress,” says Tamás Evetovits, Head of the WHO Barcelona Office for Health Systems Strengthening.
Countries with strong financial protection offer positive examples relevant for policy-makers across Europe, for example: using exemptions and caps to secure protection from co-payments, or basing entitlement to publicly financed health services on residence rather than employment or payment of contributions.
Countries with weak financial protection can redesign their co-payment policy to improve protection for poor people. “An essential first step is to introduce exemptions from co-payments for people receiving social benefits – a group that is particularly vulnerable but relatively easy to identify,” says Sarah Thomson, Senior Health Financing Specialist at the WHO Barcelona Office and the report’s lead author.
In some of these countries, however, significant progress is unlikely to be achieved without additional public investment to increase the number of medicines in the benefits package. With greater investment, countries can extend co-payment exemptions to vulnerable people who do not qualify for social benefits, so that no one is left behind, in keeping with regional commitments to equitable health in Europe.
The report was prepared by the WHO Barcelona Office for Health Systems Strengthening, part of WHO Regional Office for Europe, and benefited from funding from the Government of the Autonomous Community of Catalonia, Spain.