New WHO report shows millions of people in Europe unable to pay out-of-pocket for primary health care

A new WHO report shows that the financial hardship caused by out-of-pocket costs for medicines, medical products such as hearing aids, and dental care affects millions of people, even in Europe’s richest countries. On International Universal Health Coverage (UHC) Day 2023, the report Can People Afford Health Care? “Evidence on Financial Protection in 40 European Countries” highlights that out-of-pocket payments push 1% to 12% of households into poverty or make them poorer.

On average, out-of-pocket costs result in catastrophic medical expenses for 1% to 20% of families. In the poorest fifth of the population, this rises to 2% to 69% of households. People who experience catastrophic medical expenses may be unable to pay for other basic needs such as food, housing, and heating.

Catastrophic out-of-pocket spending is driven primarily by household expenditures on services typically provided or administered in primary care settings, suggesting significant gaps in primary care coverage in many countries.

“Our report shows that for millions of people in the WHO European Region, access to affordable health care remains a dream. Even before the pandemic, many faced unacceptable and catastrophic health expenditures level,” said Hans-Henri Krueger, WHO Regional Director for Europe. “We need to change our health systems now to ensure that people everywhere get the right care from the right person in the right place at the right time without experiencing financial hardship.”

Gaps in affordable health care

The report draws on new pre-pandemic data from 2019 to find that out-of-pocket payments for outpatient drugs can lead to financial hardship for low-income people and unmet need, leaving many without access to health care. Paying out-of-pocket for dental care can lead to financial hardship for wealthy families while leaving poor families with unmet needs.

Sandra Gallina, Director General for Health and Food Safety at the European Commission, said: “This report draws attention to gaps in access to health care for vulnerable groups and proposes policy solutions to address the challenges. I hope this work will guide Member States in improving affordable access. improve health care services and ensure a more equitable health system.”

She added: “I congratulate the World Health Organization Barcelona Health System Financing Office for publishing this valuable report on affordable health care, which is supported by the EU4Health programme.”

Redesigning health insurance policies to reduce out-of-pocket costs

In addition to providing new analysis of financial hardship and unmet health care needs, the report highlights aspects of insurance policies that undermine financial protection—the way health insurance is designed and implemented.

The report identifies 5 common health insurance policy options that slow progress towards universal health coverage because they disproportionately impact people with low incomes or chronic conditions, reduce the efficiency of health care use, and weaken the resilience of households and health systems to shocks. ability.

To address this issue, the report proposes a checklist for policymakers looking to move closer to achieving universal health coverage. The list identifies five policy options that improve financial protection in countries with low incidence of financial distress and unmet need.

  1. The right to publicly funded health care should be decoupled from the payment of social health insurance contributions. Issues of unpaid contributions and other taxes should be dealt with by the relevant tax authorities, not the health system.
  2. Refugees, asylum seekers and undocumented immigrants should be entitled to the same benefits as other residents to ensure coverage of the entire population.
  3. User fees (copayments) for health care should be used carefully and designed so that people with low incomes or chronic conditions are automatically exempt from all copayments.
  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. Coverage policies should be adequately funded through public expenditure on health to ensure that there are no severe staffing shortages, long waiting times for treatment, and no informal payments.

For more information about the 40 countries mentioned in the report, visit UHC Watch, a new online platform tracking progress towards affordable healthcare in Europe and Central Asia. UHC Watch provides rich country-level comparative data and resources on financial protection and health financing policies.

About the report

The report assesses the financial protection of 40 countries, including all EU member states, in 2019, or the most recent year before the COVID-19 outbreak, to establish a pre-pandemic baseline in Europe. It includes a simple analysis of changes in catastrophic health spending over time, as well as an exploratory analysis of catastrophic health spending during the epidemic.

This report and UHC Watch benefited from financial assistance provided by the European Union through the Directorate-General for Health and Food Safety and the Directorate-General for Neighborhoods and Enlargement Negotiations.

About WHO/Europe’s work on financial protection

Financial protection is at the heart of universal health coverage and a key aspect of health system performance evaluation. It is an indicator of the Sustainable Development Goals and is part of the European Social Rights Pillar and is central to the European Program of Work and the WHO/Europe Strategy Framework.

WHO/Europe monitors financial protection using equity-sensitive regional indicators through the WHO Health System Financing Office in Barcelona. WHO Barcelona provides countries with tailored technical assistance to reduce financial constraints and unmet needs by identifying and addressing gaps in health coverage.

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