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

Cylus, Jonathan ORCID: 0000-0001-8269-1578, Thomson, Sarah, Tayara, Lynn Al, Cerezo, José Cerezo, Martínez, Marcos Gallardo, García-Ramírez, Jorge Alejandro, Karanikolos, Marina, Gregori, María Serrano and Evetovits, Tamás (2024) Assessing the equity and coverage policy sensitivity of financial protection indicators in Europe. Health Policy, 147. ISSN 0168-8510

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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.

Item Type:	Article
Official URL:	https://www.sciencedirect.com/journal/health-polic...
Additional Information:	© 2024 The Author
Divisions:	LSE
Subjects:	H Social Sciences > HG Finance R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
JEL classification:	I - Health, Education, and Welfare > I1 - Health > I10 - General I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health C - Mathematical and Quantitative Methods > C8 - Data Collection and Data Estimation Methodology; Computer Programs > C80 - General
Date Deposited:	30 Jul 2024 09:57
Last Modified:	13 Aug 2024 16:24
URI:	http://eprints.lse.ac.uk/id/eprint/124416

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