Kaitse suurte ravikulude eest Tšehhis, Eestis ja Lätis: kolm kõrge sissetulekutasemega riiki – kolm erinevat kogemust

Eesti Arst 2018; 97(6):301–304 &nbsp

Kaitse suurte ravikulude eest Tšehhis, Eestis ja Lätis: kolm kõrge sissetulekutasemega riiki – kolm erinevat kogemust

Eesti Arst 2018; 97(6):301–304 &nbsp

Catastrophic health spending in Europe: equity and policy implications of different calculation methods

Objective To investigate the equity and policy implications of different methods of calculating catastrophic health spending. Methods We used routinely collected data from recent household budget surveys in 14 European countries. We calculated the incidence of catastrophic health spending and its distribution across consumption quintiles using four methods. We compared the budget share method, which is used to monitor universal health coverage (UHC) in the sustainable development goals (SDGs), with three other well established methods: actual food spending; partial normative food spending; and normative spending on food, housing and utilities. Findings Country estimates of the incidence of catastrophic health spending were generally similar using the normative spending on food, housing and utilities method and the budget share method at the 10% threshold of a household’s ability to pay. The former method found that catastrophic spending was concentrated in the poorest quintile in all countries, whereas with the budget share method catastrophic spending was largely experienced by richer households. This is because the threshold for catastrophic health spending in the budget share method is the same for all households, while the other methods generated effective thresholds that varied across households. The normative spending on food, housing and utilities method was the only one that produced an effective threshold that rose smoothly with total household expenditure. Conclusion The budget share method used in the SDGs overestimates financial hardship among rich households and underestimates hardship among poor households. This raises concerns about the ability of the SDG process to generate appropriate guidance for policy on UHC

How does Germany's health sector contribute to the economy?

Health matters. The health sector is an important and innovative industry, as well as a source of stable employment for many people. Health systems support active and productive populations, reduce inequities and poverty and promote social cohesion. A strong health system makes good economic sense and underpins the overall sustainable development agenda Countries around the world are grappling with the health, economic and fiscal implications of the COVID-19 pandemic. As they begin to recover from the crisis, difficult decisions will need to be made about how to allocate scarce resources. These snapshots share valuable evidence for policy-makers on how investing in health sectors and health systems helps to achieve national economic objectives

How does Switzerland's health sector contribute to the economy?

Health matters. The health sector is an important and innovative industry, as well as a source of stable employment for many people. Health systems support active and productive populations, reduce inequities and poverty and promote social cohesion. A strong health system makes good economic sense and underpins the overall sustainable development agenda Countries around the world are grappling with the health, economic and fiscal implications of the COVID-19 pandemic. As they begin to recover from the crisis, difficult decisions will need to be made about how to allocate scarce resources. These snapshots share valuable evidence for policy-makers on how investing in health sectors and health systems helps to achieve national economic objectives

Monitoring progress towards universal health coverage in Europe: a descriptive analysis of financial protection in 40 countries

Background: Ensuring that access to health care is affordable for everyone—financial protection—is central to universal health coverage (UHC). Financial protection is commonly measured using indicators of financial barriers to access (unmet need for health care) and financial hardship caused by out-of-pocket payments for health care (impoverishing and catastrophic health spending). We aim to assess financial hardship and unmet need in Europe and identify the coverage policy choices that undermine financial protection. Methods: We carry out a cross-sectional study of financial hardship in 40 countries in Europe in 2019 (the latest available year of data before COVID-19) using microdata from national household budget surveys. We define impoverishing health spending as out-of-pocket payments that push households below or further below a relative poverty line and catastrophic health spending as out-of-pocket payments that exceed 40% of a household's capacity to pay for health care. We link these results to survey data on unmet need for health care, dental care, and prescribed medicines and information on two aspects of coverage policy at country level: the main basis for entitlement to publicly financed health care and user charges for covered services. Findings: Out-of-pocket payments for health care lead to financial hardship and unmet need in every country in the study, particularly for people with low incomes. Impoverishing health spending ranges from under 1% of households (in six countries) to 12%, with a median of 3%. Catastrophic health spending ranges from under 1% of households (in two countries) to 20%, with a median of 6%. Catastrophic health spending is consistently concentrated in the poorest fifth of the population and is largely driven by out-of-pocket payments for outpatient medicines, medical products, and dental care—all forms of treatment that should be an essential part of primary care. The median incidence of catastrophic health spending is three times lower in countries that cover over 99% of the population than in countries that cover less than 99%. In 16 out of the 17 countries that cover less than 99% of the population, the basis for entitlement is payment of contributions to a social health insurance (SHI) scheme. Countries that give greater protection from user charges to people with low incomes have lower levels of catastrophic health spending. Interpretation: It is challenging to identify with certainty the coverage policy choices that undermine financial protection due to the complexity of the policies involved and the difficulty of disentangling the effects of different choices. The conclusions we draw are therefore tentative, though plausible. Countries are more likely to move towards UHC if they reduce out-of-pocket payments in a progressive way, decreasing them for people with low incomes first. Coverage policy choices that seem likely to achieve this include de-linking entitlement from payment of SHI contributions; expanding the coverage of outpatient medicines, medical products, and dental care; limiting user charges; and strengthening protection against user charges, particularly for people with low incomes. Funding: The European Union (DG SANTE and DG NEAR) and the Government of the Autonomous Community of Catalonia, Spain

Monitoring financial protection to assess progress towards universal health coverage in Europe

European countries led the way in moving towards universal health coverage in the 20th century. The economic crisis and other factors have challenged this achievement in some countries, highlighting the need for vigilance to sustain progress. Assessments of universal health coverage commonly measure health system performance in two areas: (i) the extent to which people are prevented from using services because of access barriers (unmet need for health care); and (ii) the extent to which people are shielded from financial hardship when they use health services (financial protection). The European Union regularly monitors unmet need, but Europe lacks a comprehensive set of estimates for financial protection, even though the necessary data are routinely available in most countries. To address this gap, the World Health Organization Regional Office for Europe has initiated a project to produce up-to-date estimates of financial protection using a new approach better suited to high- and middleincome countries in the region. We explain why financial protection matters, briefly review conventional ways of measuring it, show how the World Health Organization European Region’s adapted metrics add value and describe how context-specific monitoring can generate actionable evidence for policy-making

Generating evidence for UHC: systematic monitoring of financial protection in European health systems

High-performing health systems protect people from experiencing financial hardship when using needed health services. But what does financial hardship mean, how is it measured and what can policy makers learn through systematic monitoring? These are some of the questions the WHO Regional Office for Europe is addressing in a new study that uses a refined methodology to monitor financial protection across countries in Europe. The study will provide actionable information on a key indicator of universal health coverage (UHC) and an important dimension of health system performance