EUROHEALTH

22
Moving towards universal health coverage
poorest quintile – a doubling or more, an
increase of more than three percentage
points or increases in each of three or
more years – have occurred in Belgium,
Cyprus, Finland, France, Greece,
Ireland, Italy, Latvia, Luxembourg, the
Netherlands, Poland, Portugal, Spain and
the United Kingdom.
Until recently, financial protection was
not systematically monitored in Europe.
To address this gap, the WHO Regional
Office for Europe has initiated a study to
collect and analyse data on the incidence
of impoverishing and catastrophic outof-pocket
payments across a range of EU
countries (see the article by Thomson,
Evetovits, Cylus and Jakab in this issue).
Preliminary results for countries in which
pre- and post-crisis data are available
indicate an increase in financial hardship
over time in most countries.
What lessons for the future?
In assessing the effects of the crisis on
UHC, we identify three important lessons
for policy. First, for a robust assessment,
we need better data on patterns of
health service use; more internationally
comparable data on unmet need; and
more regular analysis of catastrophic and
impoverishing out-of-pocket payments.
All of these data, and data on health
spending trends, need to be made available
much more quickly than at present.
Second, it is evident that the remarkable
progress EU countries made in meeting
UHC goals in the decade before the crisis
has been partly undone as a result of
the crisis. We see this in the widespread
rise in unmet need across countries,
especially (but not only) among the
poorest households. It is not easy to tell
from the EU Survey on Income and Living
Conditions data whether the increase
in unmet need is driven by changes in
households’ financial status or changes
in the health system (or both). However,
identifying the precise source of the
increase is probably not as important
as understanding that, in any future
downturn, the health system response
must be to step up protection for poorer
households as a priority. The fact that so
many countries failed to prevent erosion
of health coverage for the most vulnerable
people should be a matter of concern to
national and international policy makers
in the EU.
Third, resilient health systems will take
steps now to ensure that fiscal pressures
do not undermine UHC achievements
in the future. This includes establishing
mechanisms to enable countercyclical
public funding for the health system;
abolishing links between population
entitlement and employment or income,
to ensure that relatively vulnerable people
do not lose entitlement if they become
unemployed or because a means-test
threshold is raised; putting in place the
infrastructure needed to make evidenceinformed
decisions about cost-effective
investment and disinvestment; and
bringing the design of co-payment policies
in line with international evidence, so that
there is effective protection for the poor
and for regular users of health services and
a cap on co-payments for everybody.
References
1
WHO. World health report 2010: Health systems
financing – the path to universal coverage. Geneva:
World Health Organization, 2010.
2
WHO Regional Office for Europe. Priorities for
health systems strengthening in the WHO European
Region 2015–2020: walking the talk on people
centredness. Copenhagen: WHO, 2015. Available at:
http://www.euro.who.int/en/about-us/governance/
regional-committee-for-europe/65th-session/
documentation/working-documents/eurrc6513-
priorities-for-health-systems-strengthening-in-thewho-european-region-20152020-walking-the-talkon-people-centredness
3
Thomson S, Figueras J, Evetovits T, et al.
Economic crisis, health systems and health in Europe:
impact and implications for policy. Policy Summary,
Copenhagen: WHO/European Observatory on Health
Systems and Policies, 2014.
4
Thomson S, Figueras J, Evetovits T, et al.
Economic crisis, health systems and health in Europe:
impact and implications for policy. Maidenhead: Open
University Press, 2015.
5
Maresso A, Mladovsky P, Thomson S (eds.)
(2015). Economic crisis, health systems and
health in Europe: country experience. Copenhagen:
WHO/European Observatory on Health Systems
and Policies.
6
Expert Panel on effective ways of investing in
Health (EXPH), Final Report on Access to Health
Services in the European Union, May 2016. Available
at: http://ec.europa.eu/health/expert_panel/index_
en.htm
7
WHO. Global health expenditure database [online
database], 2016. Available at: http://www.who.int/
health-accounts/ghed/en/
8
OECD. OECD iLibrary [online database], 2015.
Available at: http://www.oecd-ilibrary.org/
9
Eurostat. EU-SILC data on unmet need, 2016.
Available at: http://ec.europa.eu/eurostat
Good practices in strengthening
health systems for the
prevention and care of
tuberculosis and drug-resistant
tuberculosis
Edited by: C Acosta, M Dara, M Langins, H Kluge
Copenhagen: WHO Regional Office for Europe, 2015
Available for download at: http://www.euro.who.int/en/
publications/abstracts/good-practices-in-strengthening-healthsystems-for-the-prevention-and-care-of-tuberculosis-and-drugresistant-tuberculosis-2015
To improve the transfer of knowledge and experience among
countries and their use of the health-system approach to
tackle health problems, the WHO Regional Office for Europe
has collected and disseminated good examples of the
prevention, control and care of TB in the Region. In this second
compendium, it presents 45 examples of good practice in
strengthening health systems for the prevention and care of
TB and drug-resistant TB from 21 countries.
Eurohealth — Vol.22 | No.2 | 2016