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Assessing the equity and coverage policy sensitivity of financial protection indicators in Europe.
Cylus, Jonathan; Thomson, Sarah; Tayara, Lynn Al; Cerezo, José Cerezo; Martínez, Marcos Gallardo; García-Ramírez, Jorge Alejandro; Karanikolos, Marina; Gregori, María Serrano; Evetovits, Tamás.
Afiliación
  • Cylus J; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain; European Observatory on Health Systems and Policies, London, United Kingdom. Electronic address: cylusj@who.int.
  • Thomson S; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
  • Tayara LA; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
  • Cerezo JC; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
  • Martínez MG; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
  • García-Ramírez JA; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
  • Karanikolos M; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain; European Observatory on Health Systems and Policies, London, United Kingdom.
  • Gregori MS; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
  • Evetovits T; WHO Barcelona Office for Health Systems Financing, Barcelona, Spain.
Health Policy ; 147: 105136, 2024 Sep.
Article en En | MEDLINE | ID: mdl-39089167
ABSTRACT
Progress towards universal health coverage is monitored by the incidence of catastrophic spending. Two catastrophic spending indicators are commonly used in Europe Sustainable Development Goal (SDG) indicator 3.8.2 and the WHO Regional Office for Europe (WHO/Europe) indicator. The use of different indicators can cause confusion, especially if they produce contradictory results and policy implications. We use harmonised household budget survey data from 27 European Union countries covering 505,217 households and estimate the risk of catastrophic spending, conditional on household characteristics and the design of medicines co-payments. We calculate the predicted probability of catastrophic spending for particular households, which we call LISAs, under combinations of medicines co-payment policies and compare predictions across the two indicators. Using the WHO/Europe indicator, any combination of two or more protective policies (i.e. low fixed co-payments instead of percentage co-payments, exemptions for low-income households and income-related caps on co-payments) is associated with a statistically significant lower risk of catastrophic spending. Using the SDG indicator, confidence intervals for every combination of protective policies overlap with those for no protective policies. Although out-of-pocket medicines spending is a strong predictor of catastrophic spending using both indicators, the WHO/Europe indicator is more sensitive to medicines co-payment policies than the SDG indicator, making it a better indicator to monitor health system equity and progress towards UHC in Europe.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Gastos en Salud / Cobertura Universal del Seguro de Salud Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Health Policy Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2024 Tipo del documento: Article Pais de publicación: Irlanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Gastos en Salud / Cobertura Universal del Seguro de Salud Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Health Policy Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2024 Tipo del documento: Article Pais de publicación: Irlanda