The Great Recession And Increased Cost Sharing In European Health Systems

Abstract

European health systems are increasingly adopting cost-sharing models, potentially increasing out-of-pocket expenditures for patients who use health care services or buy medications. Government policies that increase patient cost sharing are responding to incremental growth in cost pressures from aging populations and the need to invest in new health technologies, as well as to general constraints on public expenditures resulting from the Great Recession (2007-09). We used data from the Survey of Health, Ageing and Retirement in Europe to examine changes from 2006-07 to 2013 in out-of-pocket expenditures among people ages fifty and older in eleven European countries. Our results identify increases both in the proportion of older European citizens who incurred out-of-pocket expenditures and in mean out-of-pocket expenditures over this period. We also identified a significant increase over time in the percentage of people who incurred catastrophic health expenditures (greater than 30 percent of the household income) in the Czech Republic, Italy, and Spain. Poorer populations were less likely than those in the highest income quintile to incur an out-of-pocket expenditure and reported lower mean out-of-pocket expenditures, which suggests that measures are in place to provide poorer groups with some financial protection. These findings indicate the substantial weakening of financial protection for people ages fifty and older in European health systems after the Great Recession

Headline indicators for monitoring the performance of health systems: findings from the european Health Systems_Indicator (euHS_I) survey

“…Thirdly, our findings are in line with the global priority areas reflected in the Sustainable Development Goals from 2015 [ 88 ]. Considering access to healthcare, it confirms the ultimate importance of financial protection in achieving comprehensive universal health insurance coverage.…”

Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece

“…Our survey data showed that average OOPE almost doubled between 2010 and 2015, mostly due to greater number of people being required to pay for prescription drugs28 and healthcare services, either as user fees for public services or increasing use of private services to avoid deteriorating conditions in the public healthcare system. Other European countries experienced increases in OOPE, following the recent recession29. The impact of the crisis on healthcare extends beyond access factors and may include declining quality of care, aging infrastructure and staff shortages, which might have important short- and long-term implications for morbidity and mortality, such as adverse events of medical care, which seem to have increased in Greece during the crisis1430.…”

Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries

“… • Does not examine perceived barriers on access to care. Palladino et al, 2016 [ 2 ] Austria, Belgium, Czech Republic, Denmark, France, Germany, Netherlands, Spain, Sweden, Switzerland Survey of people age 50 and older from Health, Ageing and Retirement in Europe, with data on changes in OOP spending and experiencing catastrophic OOP spending (30% or more of income), from 2006/7 to 2013 (Great Recession) • Very large range in changes in OOP spending (− 11% in Netherlands to + 101% in Austria). • Increase in catastrophic spending: from 2.3 to 3.9% over study period.…”