New WHO/Europe report finds too many families in Europe are falling into poverty after paying health bills

Rebuilding trust within health systems is critical to achieving universal health coverage

Tallinn, December 12, 2023

Health leaders from the WHO European Region gather in Estonia for a landmark health systems conference to mark the 15th anniversary of the Tallinn Charter which stressed that people should not be trapped in poverty due to poor health, a report covering 40 European countries A new WHO/Europe report finds that millions of people are still struggling to pay their medical bills.

The health system relies heavily on out-of-pocket payments, which means many people experience financial difficulties or face access barriers when using health care, leaving unmet needs. Out-of-pocket costs can also push some people into poverty or even make them poorer. Globally, 4.5 billion people (more than half of humanity) do not have access to basic health services.

Paying for medical bills vs. paying for food

New data from pre-pandemic 2019 shows some worrying trends. Many countries in the region have significant gaps in population health coverage: only 23 out of 40 countries report coverage of more than 99% of the population. Countries with gaps in population coverage have a three times higher incidence of catastrophic health expenditures compared with countries with coverage of more than 99% of the population.

When looking at the poorest quintile of a given country’s population, catastrophic health spending can be 2 to 5 times higher than the national average. Catastrophic health care spending means a family can no longer meet basic needs—food, shelter, and heat—because care must be paid out of pocket.

This means that the poorest people are most likely to suffer the greatest economic hardship. The incidence of catastrophic health expenditure increases over time in most countries (28) , by an average of 1.7 percentage points. Across the remaining 12 countries, the incidence of catastrophic health expenditures fell by an average of 1.8 percentage points.

Out-of-pocket payments for outpatient medicines are the main driver of economic hardship across countries, particularly for the poorest fifth of the population, followed by medical products (such as hearing aids) and dental care. Across 40 countries, drug expenditures accounted for an average of 60% of catastrophic health expenditures among the poorest 20% of households.

The pandemic has worsened the situation for many people, creating massive backlogs that force people to pay out of pocket for private healthcare and medicines, as well as insurmountable barriers to access, leading to negative health outcomes.

Drugs, medical products, and dental care are services that should be provided or administered in primary care settings. The report’s findings indicate significant gaps in primary care coverage in many countries in the region.

“Our report shows that even before the pandemic, people faced unacceptable and catastrophic levels of health spending. As we mark International Day for Universal Health Coverage (UHC), and in the wake of the disruption caused by the COVID-19 pandemic, Now is the time to get health systems back on track.” Europe.

“For millions of people across Europe, free or affordable healthcare is just a dream. Many face painful choices, such as paying for medicines or treatments at the expense of food or electricity bills. We must not let this happen. Medical costs push millions of families into poverty. After all, health is a basic human right.”

WHO/Europe urges countries to make the following five policy choices to improve financial protection and move closer to universal health coverage.

  1. Coverage policies should be adequately funded by public expenditure to ensure that there are no severe staff shortages, long waiting times for treatment, and no informal payments.
  2. The right to publicly funded health care should be decoupled from the payment of social health insurance contributions. The issue of unpaid health insurance premiums should be dealt with by the relevant tax authorities, not the health system.
  3. Healthcare user charges (co-payments) should be used carefully and should ensure that people on low incomes or with chronic conditions are automatically exempt from all charges.
  4. Primary care coverage should include treatment, not just consultation and diagnosis. This will help reduce out-of-pocket costs for medicines, medical products and dental care.
  5. Refugees, asylum seekers and undocumented immigrants should be entitled to the same benefits as other residents, with no administrative barriers to accessing their rights.

trust and transformation

When the Tallinn Charter was signed in 2008, each country in the region committed to equitably distributing the burden of financing health systems based on people’s ability to pay, so that people do not fall into poverty as a result of using health services. Fifteen years later, universal health coverage is still far from being achieved in many countries in the region.

Various studies and surveys show that a growing lack of trust in institutions and politicians is having an impact on our health system.

  • People are increasingly distrustful of the health service to be there for them when they need it.
  • Health and care workers are losing trust in the system to value them, leading to multiple strikes and industrial action across the region.
  • Politicians are distrustful of the health system’s ability to reform in the face of new challenges (for example, by leveraging digital innovation) or to address worrying issues (for example, a rapidly aging population or the recruitment and retention of health workers).

“Trust is at the heart of a well-functioning health system,” Dr. Krueger continued. “It plays a vital role in the delivery of effective and high-quality health services. If the country is to generate the required financial resources to fund the health care system, especially when people are required to provide these with taxes and other contributions When it comes to resources, trust is also crucial.”

Transforming our health systems requires rebuilding trust between the health system and 3 different social groups, all of which require different approaches:

  • Patients – Rebuilding trust by actively involving patients in care, being transparent, and promoting community engagement through citizen gatherings, etc.;
  • Health workers – rebuild trust through appropriate recruitment, retention and motivation of health workers and sensitivity to their mental health needs; and
  • Politicians/Policymakers – Rebuilding trust by investing in health leadership and governance and working with the health sector to design inclusive health policies.

“Trust is the glue that holds our society together, including our health systems. Without it, everything falls apart,” Dr. Krueger concluded.

“We need to reform our health systems to ensure that people everywhere receive the right care, at the right time, in the right place, by the right health and care staff. I call on countries to act with courage and conviction, urgently Addressing the growing trust deficit in our health system.”

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