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Assessing the equity and coverage policy sensitivity of financial protection indicators in Europe

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  • Cylus, Jonathan
  • Thomson, Sarah
  • Tayara, Lynn Al
  • Cerezo, José Cerezo
  • Martínez, Marcos Gallardo
  • García-Ramírez, Jorge Alejandro
  • Karanikolos, Marina
  • Gregori, María Serrano
  • Evetovits, Tamás

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.

Suggested Citation

  • Cylus, Jonathan & Thomson, Sarah & Tayara, Lynn Al & Cerezo, José Cerezo & Martínez, Marcos Gallardo & García-Ramírez, Jorge Alejandro & Karanikolos, Marina & Gregori, María Serrano & Evetovits, Tamás, 2024. "Assessing the equity and coverage policy sensitivity of financial protection indicators in Europe," Health Policy, Elsevier, vol. 147(C).
    • Handle: RePEc:eee:hepoli:v:147:y:2024:i:c:s0168851024001465
    DOI: 10.1016/j.healthpol.2024.105136
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    References listed on IDEAS

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    1. Cylus, Jonathan & Thomson, Sarah & Evetovits, Tamás, 2018. "Catastrophic health spending in Europe: equity and policy implications of different calculation methods," LSE Research Online Documents on Economics 89062, London School of Economics and Political Science, LSE Library.
    2. Tal Gross & Timothy J. Layton & Daniel Prinz, 2022. "The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments," American Economic Review: Insights, American Economic Association, vol. 4(2), pages 175-190, June.
    3. Rodrigo Moreno-Serra & Christopher Millett & Peter C Smith, 2011. "Towards Improved Measurement of Financial Protection in Health," PLOS Medicine, Public Library of Science, vol. 8(9), pages 1-6, September.
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