WHO Europe: Health payments are pushing people into poverty, even in high-income countries
A new WHO Europe study shows evidence that health payments (paying for medicines and health services) are unaffordable for many people and cause financial hardship across the WHO European Region, including in high-income countries. The estimates prepared with data from 25 countries show that up to 8% of households cannot afford to pay for basic needs – food, rent, utility bills – after paying out of pocket for health care.
This situation goes against the Tallinn Charter that was adopted in 2008 under the theme “health systems for health and wealth” by 53 Member States of the WHO European Region. The Tallinn Charter stipulates:
It is unacceptable that people become poor as a result of ill health”.
Europe is the region in the world with the highest alcohol consumption. Therefore, alcohol harm is widespread and a heavy burden across European countries.
Health, a fundamental human right that’s inaccessible to many, also due to alcohol
Health systems have had a rough ride since the Tallinn Charter was signed. Ten years on, the economic climate is uncertain, gaps between rich and poor continue to grow and public spending on health has not kept pace with people’s needs,” said Dr Zsuzsanna Jakab, Director General for WHO Europe.
Families are having to pay for health care out of pocket. For many it is unaffordable. We urge countries to take steps to keep these out-of-pocket payments under 15% of total spending on health.”
Even many middle- and high-income countries in the WHO European Region still rely heavily on individuals and families paying out of pocket for a large part of their health costs. In 2014, out-of-pocket payments accounted for 26% of total spending on health on average, with substantial variation (5–72%) across the Region. New evidence from WHO (PDF) shows that out-of-pocket payments have the greatest impact on those least able to pay for health care: the poorest households, people with chronic illnesses and older people. The study also finds that financial hardship is frequently linked to having to pay for medicines, particularly for poorer people.
For example, in Europe alcohol is the third leading risk factor for ill health and chronic diseases (NCDs) such as cancer, diabetes or heart disease. 12 million people in the EU are alcohol dependent in the European region.
Evidence from low-income countries like India shows that there’s an association between use of tobacco and alcohol, and impoverishment due to healthcare costs.
New evidence identifies clear steps to make health care affordable for everyone
The study finds that financial hardship – the incidence of impoverishing or catastrophic health spending – increases as the out-of-pocket share of total spending on health increases. Investing in health systems is a prerequisite for reducing out-of-pocket payments, but improving coverage policy is equally important. The European Region has a wealth of good practice, but many countries can do more to prevent people from having to choose between health care and other basic needs. Countries can reduce financial hardship through a careful redesign of user charges to minimize copayments and ensure additional protection for poor people and regular users of health care.