Rebuilding trust within and within health systems is critical to achieving universal health coverage
Tallinn, December 12, 2023
As health leaders from the WHO European region gather in Estonia for a landmark health systems conference, marking 15 years since the Tallinn Charter emphasized that people should not be poor due to poor health. A new WHO/Europe report covering 40 European countries found that: Millions of people still struggle to pay their medical bills.
The health system's heavy reliance on out-of-pocket payments means that many people experience financial hardship or face barriers to access when accessing health care, resulting in lower needs. It means you are not satisfied. Paying out-of-pocket payments can also push some people into poverty or further into poverty. Around the world, 4.5 billion people, more than half of humanity, lack essential health services.
Payment of medical expenses and food expenses
New pre-pandemic data from 2019 shows some worrying trends. Many countries in the region have wide disparities in health insurance coverage of their populations, with only 23 out of 40 countries reporting that they cover more than 99% of their populations. Countries with disparities in population coverage are three times more likely to have catastrophic health expenditures than countries that cover more than 99% of their population.
If we focus on the poorest fifth of a given country's population, catastrophic health spending can be two to five times higher than the national average. Catastrophic health spending means households can no longer afford to meet basic needs such as food, shelter, and heat because they have to pay out-of-pocket for medical care.
This means that the poorest people are most likely to suffer the most economic hardship. In the majority of countries (28), the incidence of catastrophic health spending increased over time, by an average of 1.7 percentage points. In the remaining 12 countries, the incidence of catastrophic health spending decreased by an average of 1.8 percentage points.
Out-of-pocket costs for outpatient medicines are the main source of economic hardship in each country, especially for the bottom fifth of the population, followed by medical products (such as hearing aids) and dental care. For the poorest 20% of households, on average across 40 countries, 60% of catastrophic health spending is on medicines.
The pandemic has worsened the situation for many, creating huge arrears that can force people to pay out of pocket for private healthcare and medicines, and where there are insurmountable barriers to access. leading to negative effects on health.
Pharmaceuticals, medical products, and dental care are services that should be provided or managed in primary care settings. The report's findings show that there are significant disparities in primary care coverage in many countries in the region.
“Our report shows that even before the pandemic, people were facing unacceptable levels of catastrophic health spending. As we mark International Universal Health Coverage (UHC) Day, , the time has come to get health systems back on track following the devastation caused by the COVID-19 pandemic,” said Dr. Hans-Henry P. Kluge, WHO Regional Director. Europe.
“For millions of people in the European region, free or affordable healthcare is just a dream. Many face excruciating choices, such as paying for medicines and treatments at the expense of food and utilities. We cannot allow health care costs to impoverish millions of families. After all, health is a fundamental human right.”
WHO/Europe calls on countries to make five policy choices to improve financial protection and move closer to UHC:
- Insurance policies must be adequately funded by public spending to ensure that there are no significant staffing shortages, long waiting times for treatment, or informal payments.
- The right to publicly funded health care should be separated from the payment of social insurance premiums. Non-payment of health insurance premiums should be dealt with by the competent tax office, not by the medical system.
- User charges (copays) should be applied sparingly and designed to automatically waive all charges for people with low incomes and chronic conditions.
- Primary care insurance should cover treatment as well as consultation and diagnosis. This leads to lower out-of-pocket costs for medications, medical products, and dental care.
- Refugees, asylum seekers and illegal immigrants should be entitled to the same benefits as other residents, without administrative barriers to accessing their rights.
Trust and change
When signing the Tallinn Charter in 2008, each country in the region committed to ensuring that the financial burden of health systems is distributed equitably according to people's ability to pay, so that people do not fall into poverty as a result of access to health services. promised. Fifteen years later, UHC remains far from reality in many countries in the region.
Various studies and surveys point out that distrust of medical institutions and politicians is increasing, which is affecting the healthcare system as a result.
- More and more people no longer trust that health services will be available when they need them.
- Health and care workers are losing confidence that the system values them, leading to multiple strikes and industrial action across the region.
- Politicians will assess the ability of health systems to reform in the face of new challenges (e.g., by leveraging digital innovation) and to address concerns (e.g., rapidly aging populations and the recruitment and retention of health workers). I don't trust your ability to do that.
“Trust is at the very heart of a well-functioning health care system,” Dr. Kluge continued. “It plays an important role in providing effective and high-quality health services. Particularly when countries want to generate the necessary resources to fund their health systems, people can rely on taxes and other contributions. Trust is also essential when we are asked to provide these financial resources.”
Transforming our health system will require rebuilding trust between it and three different social groups, all of which require different approaches.
- Patients – Rebuild trust by actively involving patients in their care, being transparent, and fostering community involvement, for example through public assemblies.
- Health workers – Rebuild trust by better recruiting, retaining and motivating health workers and being sensitive to their mental health needs.and
- Politicians/Policy Makers – Rebuild trust by investing in health leadership and governance and working with the health sector to develop comprehensive health policies.
“Trust is the glue that holds our society together, including our health care systems. Without it, everything falls apart,” Dr. Kluge concluded.
“We need to transform our health systems to ensure that wherever we are, we get the right care, in the right place, by the right health care provider, at the right time. , we call on you to act with courage and conviction and urgently address the growing lack of trust in our health care system.”
