Health payments causing poverty, even in high-income countries

Health payments causing poverty, even in high-income countries

The costly nature of health payments is unaffordable and causes financial strain to the point of poverty, even in high-income countries, according to a new study by the World Health Organization (WHO).

According to estimates prepared with data from 25 countries in the European Region, up to 8% of households cannot afford to pay for basic needs – food, rent and utility bills – following expensive health payments.

These findings go against the Tallinn Charter adopted by 53 member states of the region in 2008, which states: ‘It is unacceptable that people become poor as a result of ill health.’

Asking the tough questions on medical care payments

At the high-level WHO meeting ‘Health systems for prosperity and solidarity, leaving no one behind’ being held in Tallinn, Estonia, on 13-14 June, the tough questions will be asked.

WHO regional director Dr Zsuzsanna Jakab commented: “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.

“Families are having to pay for healthcare 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. This meeting is about honouring the legacy of the Tallinn Charter by working together to include, invest and innovate for the good of everyone in the European Region.”

The impact of ‘out-of-pocket’ payments

Many of the middle- and high-income countries in the region still rely heavily on individuals and families paying out of pocket for a substantial part of their health costs.

In 2014, out-of-pocket payments accounted for, on average, 26% of total spending, with substantial variation (5-72%) across the region.

New evidence from the WHO shows that out-of-pocket payments have the greatest impact on those least able to pay for healthcare:

  • The poorest households;
  • People with chronic illnesses; and
  • Older people.

The study also found that financial hardship is frequently linked to having to pay for medicines, particularly for poorer people.

What can be done to make healthcare more affordable?

Improving coverage policy is an important factor in lifting the issue. More needs to be done to prevent people from having to choose between healthcare and basic needs.

WHO advises that countries could reduce the financial strain through a careful redesign of user charges to minimise co-payments and ensure additional protection for poor people and regular users of healthcare.

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