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April 11, 2019
David Burda
Economics Policy System Dynamics

The Universal Patient Experience of Debilitating Healthcare Costs

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 Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. 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.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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