Subscribe Now

Stay current on all 4sight Health’s Insights.


Listen & subscribe to 4sight Roundup podcast.

Dave Burda hosts a weekly podcast discussing news that impacts market-based change. Subscribe on your streaming service.

Listen Here

The Universal Patient Experience of Debilitating Healthcare Costs

Blog | 
Policy | 
System Dynamics | 

The lack of affordable medical care isn’t just a U.S. phenomenon. It’s a serious problem across Europe, according to a new report from the World Health Organization. WHO’s report identified some dos and don’ts that affect healthcare affordability across the pond and, by doing so, gave policymakers here a few things to scratch their heads over as they try to solve healthcare’s most vexing challenge.

The report is Can People Afford to Pay for Health Care? New Evidence on Financial Protections in Europe. The WHO Barcelona Office for Health Systems Strengthening produced the 144-page report, which you can download here.

WHO researchers compared healthcare “financial protection” in 24 European countries. They said financial protection is measured by two indicators:

  • Impoverishing health spending. Defined as out-of-pocket healthcare spending that pushes a household below the poverty level in each country.
  • Catastrophic health spending. Defined as out-of-pocket healthcare spending that forces a household to spend less on basics like food, housing and utilities without drawing on their savings, selling assets or borrowing money.

The researchers looked at the percentages of households in each country that met the definitions of those two financial protection measures.

The percentage of households suffering from impoverishing health spending ranged from a low of 0.3 percent in Slovenia to a high of 9 percent in the Ukraine. The percentage of households suffering from catastrophic health spending ranged from a low of 1 percent in Slovenia to a high of 17 percent in the Republic of Moldova.

The out-of-pocket expenses most responsible for driving people into poverty or requiring them to pick between medical care and food in each country, according to the report, were: outpatient prescription drug costs; inpatient hospital costs and dental care costs.

“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,” the researchers said.

Perhaps of most interest to policymakers here who are always hearing about how much better things are over there is Table 10 on p. 104 of the WHO report. The researchers looked at four health system levers in each country and the actions taken under each lever in each country that made care more or less affordable for its citizens.

The four features were: population entitlement; benefits package; user charges; and voluntary health insurance. For example:

  • Under population entitlement, the researchers said do cover whole populations, including undocumented migrants and don’t base coverage on employment.
  • Under benefits package, the researchers said do prioritize benefits according to population health needs and don’t pass unfunded coverage mandates.
  • Under user charges, the researchers said do cap co-payments as a percentage of household income and don’t let providers balance bill.
  • Under voluntary health insurance, the researchers said do lower your expectations that private health insurance can  meet your universal coverage goals and don’t rely on commercial health plans to close gaps in coverage.

Whether the dos and don’ts would work here, apply here or even be considered here is debatable. But we’re at a point at which someone here has to bust up the status quo that’s responsible for making care less and less affordable for most Americans.

Healthcare affordability was top of mind earlier this month with the release of the study in Health Affairs that said health insurance premiums are rising faster than household incomes and the survey by Gallup and West Health that said Americans are borrowing billions to pay for medical care.

As the new WHO report shows, affordability is a global issue that will take bold actions to overcome.

To learn more about this topic, please read 4sight Health’s “An Unbearable Burden: Paying for Commercial Health Insurance” on our website here.


David Burda is a columnist for 4sight Health and news editor of 4sight Friday, our weekly newsletter. Follow Burda on Twitter @DavidRBurda and on LinkedIn. Read his bio here

About the 4sight Health Author
David Burda News Editor & Columnist

Dave is 4sight Health’s biggest news junkie, resident journalist and healthcare historian. He began covering healthcare in 1983 and hasn’t stopped since. Dave writes his own column, “Burda on Health,” for us, contributes weekly blog posts, and manages our weekly e-newsletter and weekly podcast, 4sight Friday and 4sight Roundup. Dave believes that healthcare is a business like any other business, and customers—patients—are king. If you do what’s right for patients, good business results will follow. Follow Burda on Twitter @DavidRBurda and on LinkedIn.