By Euractiv's Health Hub and Giedre Peseckyte | Euractiv

Est. 9min

21-09-2022 (updated: 23-09-2022 )

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Out-of-pocket payments for healthcare carry a heavy burden for a number of Europeans, making them choose between basic needs and healthcare.

The well-known saying ‘health is wealth’ can be turned into a different one for some Europeans: ‘health for the wealthy’.

It’s hardly unusual to undergo a specific treatment or incur medical expenses that are not fully covered by private or public insurance.

One can also buy medical products or just decide to go to a private hospital and pay for a doctor’s visit instead of waiting for an appointment in a public hospital that would be covered by public insurance.

In the medical jargon, these are known as out-of-pocket payments and occur in all health systems, but they may create a financial burden affecting the household income.

Not only can direct payments by patients for their health limit access to healthcare options, depending on their income, but they may force people to choose between health and other essential spending, the Organisation for Economic Co-operation and Development (OECD) has warned.

The World Health Organisation (WHO) estimated that in the European Union in 2019, more than 15% of all health spending is borne directly by private households, which is 3% lower than the world average.

But this figure ranges from around 10% in France, Luxembourg and the Netherlands to nearly 40% in Bulgaria, Greece, or Malta.

“Heavy reliance on out-of-pocket payments for health care is a challenge to universal health coverage – the idea that everyone should be able to use quality health services without experiencing financial hardship,” said Tamás Evetovits, head of the WHO Barcelona office for health systems financing.

He said that when talking about Bulgaria’s healthcare, based on the Bulgarian parliament, in 2018, one in five households incurred out-of-pocket payments that exceeded their capacity to pay for healthcare by at least 40%.

Catastrophic health spending

Basically, this means that people had to cut their budget for other basic needs such as paying taxes or buying food.

This phenomenon carries another term – ‘catastrophic health spending’, which means that the medical spending of a household exceeds a certain level of capacity to pay.

As out-of-pocket spending for health weighs more on those with lower income, some patients may simply forgo needed care if costs are too high, OECD stressed.

“The people most likely to experience catastrophic health spending are those in the poorest quintile, older people and households in rural areas,” a WHO press release said.

It is worrying that the incidence of catastrophic health spending has grown over time, pushed up by a large increase in the poorest quintile.

The catastrophic health spending is led by expenses for outpatient medicines, medical products and inpatient care. “In the poorest households, financial hardship is almost entirely driven by outpatient medicines,” the WHO said.

In another EU country, Romania, in 2015, one in eight households incurred out-of-pocket payments that exceeded 40% of their capacity to pay for health care, the WHO report revealed.

The analysis showed that catastrophic health spending is heavily concentrated among the poorest 40% of households and older people and is mainly driven by out-of-pocket payments for outpatient medicines, followed by dental care and outpatient care.

Between 2010 and 2015, the rates of unmet need for health care and dental care in Romania continue to be well above the EU average, even though out-of-pocket payments do not reach 20% of health expenditure in the country.

Spain, a country where out-of-pocket payments make a bit over 20% of health expenditure, has one of the lowest incidences of catastrophic health spending in Europe, in contrast to other mentioned countries.

It seems that it all comes down to strengths in the design of national health system (NHS) coverage policy and the highly redistributive effect of public spending on health, another WHO report said.

Health for all

Within the framework of the Sustainable Development Goals (SDGs) of the United Nations, the provision of financial protection for everyone, regardless of income, is a distinct health system goal and a dimension of universal health coverage.

And the European Commission has always been committed to mainstreaming SDGs into EU policies and initiatives.

In 2018, the countries of the WHO’s European region renewed their commitment to promoting shared values of solidarity, equity and participation through health policies with a specific focus on poor and vulnerable groups.

In particular, they highlighted the importance of moving towards universal health coverage for a Europe free of impoverishing payments for health, and of specifying ways of improving coverage, access and financial protection for everyone.

WHO set some targets for ensuring access to healthcare by making sure that national health insurance covers the whole population with the same set of benefits, limiting the ability of healthcare providers for extra billing, addressing informal payments and reducing the price of medicines.

These are just some of the possible ways, as each healthcare system is different and, as shown with previous examples, even if out-of-pocket payments are at similar levels, it doesn’t create the same financial burden for patients.

By Giedre Peseckyte

Subscribe to EURACTIV’s Health Brief, where you’ll find the latest roundup of news covering health from across Europe. The Health Brief is brought to you by EURACTIV’s Health Team Giedrė Peseckytė, Clara Bauer-Babef, Amalie Holmgaard Mersh, and Gerardo Fortuna.

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