Out-of-pocket payments for health can create a financial barrier to access, resulting in unmet need, or lead to financial hardship for people using health services. This report brings together for the first time data on unmet need and financial hardship to assess whether people living in Europe can afford to pay for health care.

Drawing on contributions from national experts in 24 countries, the report shows that financial hardship varies widely in Europe, and that there is room for improvement even in high-income countries that provide the whole population with access to publicly financed health services. Catastrophic health spending is heavily concentrated among the poorest households in all of the countries in the study. Where financial protection is relatively weak, catastrophic spending is mainly driven by out-of-pocket payments for outpatient medicines.

Health systems with strong financial protection and low levels of unmet need share the following features:

  • there are no large gaps in health coverage;
  • coverage policy – the way in which coverage is designed, implemented and governed – is carefully designed to minimize access barriers and out-of-pocket payments, particularly for poor people and regular users of health services;
  • public spending on health is high enough to ensure relatively timely access to a broad range of health services without informal payments; and as a result
  • out-of-pocket payments are low, accounting for less than or close to 15% of current spending on health.

Gaps in coverage arise from weaknesses in the design of three policy areas: population entitlement, the benefits package and user charges (co-payments). The report summarizes actions that can reduce unmet need and financial hardship by strengthening coverage policy. It also highlights actions that should be avoided.

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