UN
Inflation and war are threatening the financial security of millions of people in the European Region. On Universal Health Coverage Day (12 December), WHO/Europe calls on countries to learn from previous shocks and prevent out-of-pocket payments for health care from pushing people into poverty this winter.
Evidence shows that, after the economic crisis that followed the global financial crisis in 2008, cuts and slower growth in public spending on health led to staff shortages, longer waiting times and coverage restrictions in many countries in the European Region, widening inequality in affordable access to health care. For example, 6 countries restricted entitlement to publicly financed health care, typically affecting people in precarious situations; 17 countries reduced the scope of health benefits; and 24 countries increased user charges (co-payments).
In countries with the largest cuts to health budgets, the share of people foregoing health care due to cost doubled, and the financial hardship caused by out-of-pocket payments also increased, according to an analysis carried out by the WHO Barcelona Office for Health Systems Financing.
Even before the current shocks, out-of-pocket payments for health care pushed as many as 1 in 10 households into poverty – or further into poverty – in some countries of the Region. In addition, 1–19% of households (depending on the country) incurred catastrophic health spending (out-of-pocket payments that exceeded 40% of their remaining household income, once basic needs had been met), which meant they could no longer afford to meet other basic needs such as food, housing and heating.
As the European Region grapples with war, a cost-of-living crisis and rising energy costs, WHO/Europe urges countries to heed the lessons from the 2008 financial crisis, step up public spending on health and give priority to protecting the people most in need, which is now more important than ever.
Protecting people with low incomes
Research shows that people with low incomes are most likely to experience catastrophic out-of-pocket payments, mainly due to spending on medicines and medical products.
“Financial hardship can force people to choose between feeding their family, heating their home or taking the medicines they need,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “Building a healthier society means governments invest in health systems, especially in times of crisis, to ensure health for all, everywhere.”
To sustain progress towards universal health coverage, countries need to close the gaps in health coverage that typically affect households with low incomes. For example, they should ensure that:
- national health insurance schemes cover people in informal or precarious work;
- publicly financed health benefits include a wide range of outpatient medicines;
- people with low incomes are exempt from having to pay user charges for health care, especially co-payments for outpatient medicines;
- administrative barriers do not prevent people from accessing services to which they are entitled.
Protecting people affected by conflict
In the context of the Ukraine war, people fleeing conflict need access to the full range of health services, including medicines, without administrative, communication or financial barriers.
Providing health care for refugees may have a significant impact on host countries’ health budgets. This pressure can be alleviated by allocating additional public funds to address increased health needs. Higher external funding, especially for middle-income countries and those hosting large numbers of refugees, would allow support to be delivered more effectively.
For those who remain in Ukraine, ensuring affordable access to health care is a challenge. The war is likely to reverse Ukraine’s progress towards universal health coverage through the worsening economic situation of most households.
However, changes to health financing policy, including coverage policy, can soften the effects for those in need. People pushed into poverty by the conflict should be protected from financial barriers and catastrophic out-of-pocket payments, particularly older people with chronic conditions.
WHO/Europe is providing technical support to Ukraine in this area.