Financial protection in Europe: a systematic review of the literature and mapping of data availability

Yerramilli, Pooja; Fernández, Oscar Saavedra; Thomson, Sarah

doi:10.1016/j.healthpol.2018.02.006

Cited by 28 publications

(52 citation statements)

References 37 publications

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“…On the measurement issue of social inclusion in health systems and health insurance, a study published by WHO on financial protection in Europe, found that the association between gaps in population coverage and financial hardship is weak because people lacking coverage usually only account for a small share of the population, and European countries generally provide all residents with access to emergency services, which is often not the case in LMIC [123]. However, the incidence of catastrophic health spending and financial protection still varies hugely among households in Europe, especially among countries that joined the EU after 30 April 2004 [123, 124]. Similar strategies, such as exemptions for poor people and regular users of health services – e.g.…”

Section: Discussionmentioning

confidence: 99%

Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review

Hees

O’Fallon

Hofker³

et al. 2019

Int J Equity Health

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Background One way to achieve universal health coverage (UHC) in low- and middle-income countries (LMIC) is the implementation of health insurance schemes. A robust and up to date overview of empirical evidence assessing and substantiating health equity impact of health insurance schemes among specific vulnerable populations in LMICs beyond the more common parameters, such as income level, is lacking. We fill this gap by conducting a systematic review of how social inclusion affects access to equitable health financing arrangements in LMIC. Methods We searched 11 databases to identify peer-reviewed studies published in English between January 1995 and January 2018 that addressed the enrolment and impact of health insurance in LMIC for the following vulnerable groups: female-headed households, children with special needs, older adults, youth, ethnic minorities, migrants, and those with a disability or chronic illness. We assessed health insurance enrolment patterns of these population groups and its impact on health care utilization, financial protection, health outcomes and quality of care. Results The comprehensive database search resulted in 44 studies, in which chronically ill were mostly reported (67%), followed by older adults (33%). Scarce and inconsistent evidence is available for individuals with disabilities, female-headed households, ethnic minorities and displaced populations, and no studies were yielded reporting on youth or children with special needs. Enrolment rates seemed higher among chronically ill and mixed or insufficient results are observed for the other groups. Most studies reporting on health care utilization found an increase in health care utilization for insured individuals with a disability or chronic illness and older adults. In general, health insurance schemes seemed to prevent catastrophic health expenditures to a certain extent. However, reimbursements rates were very low and vulnerable individuals had increased out of pocket payments. Conclusion Despite a sizeable literature published on health insurance, there is a dearth of good quality evidence, especially on equity and the inclusion of specific vulnerable groups in LMIC. Evidence should be strengthened within health care reform to achieve UHC, by redefining and assessing vulnerability as a multidimensional process and the investigation of mechanisms that are more context specific. Electronic supplementary material The online version of this article (10.1186/s12939-019-1040-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review

Hees

O’Fallon

Hofker³

et al. 2019

Int J Equity Health

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“…Since the seminal work by Xu et al [6], a large body of literature on the incidence of CHE has emerged and developed. However, in a systematic review of literature [7] several gaps were identified, namely the scarcity of up-to-date analysis and a bias of the literature towards middle-income countries. Few studies analysed trends over time and not many developed equity analyses (and most equity analyses correspond to the calculation of CHE by expenditure or income quintiles).…”

Section: Introductionmentioning

confidence: 99%

Evolution of catastrophic health expenditure in a high income country: incidence versus inequalities

Quintal

2019

Int J Equity Health

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Background Catastrophic health expenditure (CHE) is well established as an indicator of financial protection on which there is extensive literature. However, most works analyse mainly low to middle income countries and do not address the different distributional dimensions of CHE. We argue that, besides incidence, the latter are crucial to better grasp the scope and nature of financial protection problems. Our objectives are therefore to analyse the evolution of CHE in a high income country, considering both its incidence and distribution. Methods Data are taken from the last three waves of the Portuguese Household Budget Survey conducted in 2005/2006, 2010/2011 and 2015/2016. To identify CHE, the approach adopted is capacity to pay/normative food spending, at the 40% threshold. To analyse distribution, concentration curves and indices (CI) are used and adjusted odds ratios are calculated. Results The incidence of CHE was 2.57, 1.79 and 0.46%, in 2005, 2010 and 2015, respectively. CHE became highly concentrated among the poorest (the respective CI evolved from − 0.390 in 2005 to − 0.758 in 2015) and among families with elderly people (the absolute CI evolved from 0.520 in 2005 to 0.740 in 2015). Absolute CI in geographical context also increased over time (0.354 in 2015, 0.019 in 2005). Medicines represented by far the largest share of catastrophic payments, although, in this case concentration decreased (the median share of medicines diminished from 93 to 43% over the period analysed). Contrarily, the weight of expenses incurred with consultation fees has been growing (even for General Practitioners, despite the NHS coverage of primary care). Conclusions The incidence of CHE and inequality in its distribution might progress in the same direction or not, but most importantly policy makers should pay attention to the distributional dimensions of CHE as these might provide useful insight to target households at risk. Greater concentration of CHE can actually be regarded as an opportunity for policy making, because interventions to tackle CHE become more confined. Monitoring the distribution of payments across services can also contribute to early detection of emerging (and even, unexpected) drivers of catastrophic payments.

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“…In addition to being easy to calculate, the measure is intuitively appealing. Both characteristics have contributed to its widespread application (Limwattananon et al, 2007;Van Doorslaer et al, 2007;Xu et al, 2007;Dmytraczenko and Almeida, 2015;Cylus et al, 2018;Wang et al, 2018;Yerramilli et al, 2018).…”

Section: Catastrophic Paymentsmentioning

confidence: 99%

Financial Protection Against Medical Expense

O’Donnell

2019

SSRN Journal

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Financial protection is claimed to be an important objective of health policy. Yet there is a lack of clarity about what it is and no consensus on how to measure it. I address the ambiguity of meaning by considering three questions: Protection of what? Protection against what? Protection with what? The proposed answers lead to the suggestion that financial protection is about shielding nonmedical consumption from the cost of healthcare using formal health insurance and public finances, as well as informal and self insurance mechanisms that do not impair earnings potential. Given this definition, I evaluate four approaches to the measurement of financial protection: a) consumption smoothing over health shocks; b) the risk premium; c) catastrophic healthcare payments; and, d) impoverishing healthcare payments. The first of these does not restrict attention to medical expenses, which limits its relevance to health financing policy. The second rests on assumptions about risk preferences. No measure is entirely satisfactory in its treatment of medical expenses that are financed through informal and self insurance instruments. By ignoring these sources of imperfect insurance, the catastrophic payments measure overstates the impact of out-of-pocket medical expenses on living standards, while the impoverishment measure does not credibly identify poverty caused by them. It is better thought of as a correction to the measurement of poverty.

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Financial protection in Europe: a systematic review of the literature and mapping of data availability

Abstract: The literature provides little actionable evidence on financial protection in Europe.

Cited by 28 publications

References 37 publications

Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review

Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review

Evolution of catastrophic health expenditure in a high income country: incidence versus inequalities

Financial Protection Against Medical Expense

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