Division of Health Systems & Public Health

Monitoring financial protection

Tamás Evetovits & Sarah Thomson WHO Barcelona Office for Health Systems

Strengthening

OECD meeting of the Joint Network on Fiscal

Sustainability of Health Systems, 4-5 February 2016

Universal health coverage (UHC)

All people should get access to needed health services of sufficient quality to be effective (including prevention, promotion, treatment, medicine, rehabilitation and palliative care) without the risk of being exposed to financial hardship

Two important measures for UHC

Unmet

need

Financial protection

0

5

10

15

20

25

30

Slo

ve

nia

Neth

erland

s

Austr

ia

Malta

Un

ite

d K

ing

do

m

Spain

Den

mark

Czech R

ep

ublic

Luxem

bo

urg

Slo

va

kia

Sw

ed

en

Germ

any

Ire

lan

d

Lithuan

ia

Port

ugal

Belg

ium

Fra

nce

Fin

land

EU

28

Hun

gary

Cypru

s

Cro

atia

Esto

nia

Pola

nd

Rom

ania

Italy

Gre

ece

Bulg

aria

Latv

ia

%

Poorest

Average

Richest

Unmet need even in high-income countries Unmet need for a medical examination for financial or other reasons by

income grous in the European Union, EU-SILC data for 2013

Out-of-pocket spending as a proxy to

financial protection

OOPs

Out-of-pocket payments (OOPs) as % of total

spending on health by income country group

(high, upper-middle, lower-middle and low)

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

Ne

therl

and

sM

onaco

Fra

nce

UK

Lu

xe

mbo

urg

Slo

ven

iaG

erm

any

San M

arin

oD

enm

ark

No

rwa

yC

roa

tia

Czech R

epu

blic

Irela

nd

Austr

iaS

wede

nA

ndo

rra

Icela

nd

Esto

nia

Fin

land

Belg

ium

Ita

lyS

pain

Pola

nd

Slo

vakia

Isra

el

Hu

nga

ryS

witzerl

and

Lithu

ania

Gre

ece

Port

ug

al

Ma

lta

Ru

ssia

n F

ed

era

tion

La

tvia

Bulg

aria

Cypru

s

Turk

ey

Bela

rus

Ro

man

iaB

osnia

an

d H

erz

eg

ovin

aT

FY

RM

Mo

nte

neg

roT

urk

men

ista

nS

erb

iaK

azakhsta

nA

lba

nia

Aze

rbaija

n

Kyrg

yzsta

nU

kra

ine

Uzbe

kis

tan

Re

pub

lic o

f M

old

ova

Arm

enia

Geo

rgia

Tajik

ista

n

Source: WHO data for 2011

Red zone

Alarming

<15%

Where governments spend more,

patients pay less, but policies matter

Source: WHO estimates for 2012, selected countries with population > 600,000

More public spending and

better health policies

Make sure poorer people are protected

<15%

Reduce OOPs for poorer people

15-30%

Increase public spending

and make it pro-poor

>30%

Measures of financial protection

Impoverishing

health

expenditure

Catastrophic health

expenditure

Basic needs

Cumulative distribution of the population

Househ

old

consum

ption

Before OOPs

After OOPs

no OOPs 1

5 further impoverished by OOPs

4 impoverished by OOPs

at risk of being impoverished by OOPs 3

2 not at risk of being

impoverished by OOPs

Multiple of basic needs (eg 120%)

Source: WHO 2015

Impoverishing health expenditure

Methodology matters: do richer people really suffer

the most? OOPs > 25% of a household’s budget in global monitoring

1

1.4

1.9 1.9

2.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Poorest 2 3 4 Richest

%

Source: Median values for 37 countries; WHO-WB global monitoring framework 2015

Capacity to pay

Basic needs

Cumulative distribution of the population

Ho

use

ho

ld c

on

su

mp

tio

n

Before OOPs

After OOPs

Catastrophic health spending: capacity to pay approach

(includes any OOPs that leave households impoverished)

Catastrophic health spending C

C also further impoverished by OOPs

C also impoverished by OOPs

C

C

40%

Source: WHO 2015

Preliminary results for selected EU countries

before the financial and economic crisis 0

.1%

1.1

%

1.2

%

2.9

%

7.4

%

10

.0%

10

.3%

10

.6%

11

.5%

0%

20%

40%

60%

80%

100%

SV

N 2

00

7

IRL

20

09

CZ

E 2

009

CY

P 2

00

9

GR

C 2

008

LV

A 2

00

8

ES

T 2

00

7

PR

T 2

005

LT

U 2

008

No OOP spending

Not-at-risk of impoverishmentafter OOP spending

At-risk of impoverishment afterOOP spending (Below 120%)

Impoverished by OOPspending

More impoverished by OOPspending

Catastrophic (>40%)

Source: WHO 2015

The poorest households are consistently at

greatest risk of catastrophic spending

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

SV

N 2

007

IRL

20

09

CZ

E 2

009

CY

P 2

009

GR

C 2

00

8

LV

A 2

00

8

ES

T 2

00

7

PR

T 2

005

LT

U 2

008

1 (poorest) 2 3 4 5 (richest)

Source: WHO 2015

Consumption

quintiles:

Removing financial barriers

Increase PUBLIC spending

Reduce OOPs

Reduce waste

Our vision at WHO/Europe

Europe free of

impoverishing health

expenditures

WHO Barcelona Office for Health

Systems Strengthening

Established in 1999

Supported by the Government of the

Autonomous Community of Catalonia, Spain

Focuses on health systems financing:

analytical work and capacity building

Staff work directly with Member States across

the European Region

Part of the Division of Health Systems &

Public Health of the WHO Regional Office for

Europe www.euro.who.int

Contact us:

Sant Pau Art Nouveau Site

Nostra Senyora de La Mercè pavilion

Sant Antoni Maria Claret 167

08025 Barcelona, Spain

Email: whobar@euro.who.int