Can People Afford to Pay for Healthcare? New Evidence on Financial Protection in Europe (F7)

“No one should have to choose between healthcare and other basic needs” – this essential message was delivered by Tamás Evetovits, Head of the WHO Barcelona Office for Health Systems Strengthening, WHO Regional Office for Europe, in this afternoon workshop organised by World Health Organisation (WHO) Regional Office for Europe and moderated by the witty Prof. Charles Normand.

Tamás engaged the audience by using the metaphor of an umbrella and its strength in different weather conditions to illustrate the durability of universal health coverage (UHC). He enforced that UHC means that no one should experience financial hardship and unmet need. An evocative video showed the real life examples of people like Lisa, a patient who had to choose between paying either for her electricity bill or prescription medicines.

Jonathan Cylus, Economist and London Hub Coordinator, European Observatory on Health Systems and Policies, discussed two metrics used to capture financial hardship: catastrophic out of pocket (OOP) payments and impoverishing OOP payments. Catastrophic OOP payments are those greater than 40% of a household’s capacity to pay after deducting standard needs, while impoverishing OOP payments are those that, once paid, cause a household to fall below the poverty line. Johnathan discussed the bespoke WHO methodology used in the “Can people afford to pay for health care? New evidence on financial protection in Europe (2019)” regional report. (1)

Sarah Thomson, Senior Health Financing Specialist, WHO Barcelona Office for Health Systems Strengthening, WHO Regional Office for Europe elaborated on how we can we improve financial protection especially for the poor.

Triin Habicht, WHO consultant & former Head of the Department of Health System Development, Ministry of Social Affairs, Estonia, discussed the reform of Estonia’s pharmaceutical co-payment system. Post reform, 134,000 people per year now benefit from additional coverage. Triin also alluded to the electronic health insurance fund (EHIF): when a patient goes into the pharmacy to acquire prescription medicines, their specific co-payment value owed adjusts automatically because of the EHIF. As a practising pharmacist, I would love to see this reformed system implemented in my home country of Ireland, as it would mean patients would not overpay as is sometimes the case.

Kaisa Immonen, Director of Policy, European Patients’ Forum argued that we all need to “look behind the figures” and increase public patient involvement (PPI) in the area of healthcare access. Stefan Eichwalder, Cabinet of the Minister, Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, Austria gave an overview of his country’s complex healthcare system. Martin Seychell, Deputy Director-General, European Commission Directorate-General for Health and Food Safety (DG SANTE) told the audience “not to rely too much on the headline figures of just how many people are covered “ and “look at what services actually are covered/offered“. He added that if we not cover a lot of services then we have a lot of unmet need.

After an animated panel discussion, Charles Normand concluded the session by elaborating on equity in healthcare saying access can be disease-specific, so choosing the right disease for yourself can be crucial. The audience burst into laughter.


  • Can people afford to pay for health care? New evidence on financial protection in Europe (2019), By Sarah Thomson, Jonathan Cylus and Tamás Evetovits, 2019, xv + 116 pages, ISBN 978 92 890 5405 8,

This Blog was written by the Young Gasteiner Gary L O’Brien

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