The inability to pay for health services in Central and Eastern Europe: evidence from six countries

Abstract

Background: Out-of-pocket payments for health services constitute a major financial burden for patients in Central and Eastern European (CEE) countries. Individuals who are unable to pay use different coping strategies (e.g. borrowing money or foregoing service utilization), which can have negative consequences on their health and social welfare. This article explores patients’ inability to pay for outpatient and hospital services in six CEE countries: Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. Methods: The analysis is based on quantitative data collected in 2010 in nationally representative surveys. Two indicators of inability to pay were considered: the need to borrow money or sell assets and foregoing service utilization. Statistical analyses were applied to investigate associations between the indicators of inability to pay and individual characteristics. Results: Patient payments are most common in Bulgaria, Ukraine, Romania and Lithuania and often include informal payments. Romanian and, particularly, Ukrainian patients most often face difficulties to pay for health services (with approximately 40% of Ukrainian payers borrowing money or selling assets to cover hospital payments and approximately 60% of respondents who need care foregoing services). Inability to pay mainly affects those with poor health and low incomes. Conclusion: Widespread patient payments constitute a major financial barrier to health service use in CEE. There is a need to formalize them where they are informal and to take measures to protect vulnerable population groups, especially those with limited possibilities to deal with payment difficulties.

Health promotion for older people in Lithuania: Between bureaucratic and financial constraints

“…The health care reforms during the transition period, resulted in the creation of a decentralized insurance-based health system predominantly funded by the National Health Insurance Fund (NHIF) based on compulsory insurance contributions. However, there are also high out-of-pocket payments, which are a cause for concern as they threaten the access to health care for vulnerable groups [3,5]. With the decentralization of the health system in the 1990s, the provision of primary and social care, and public health activities at the local level became the responsibility of the municipalities.…”

The Informal Payments and their Managerial Implications in the Medical System. An Analysis from the Perspective of the Values and of the “Gift Culture” in the Romanian People

“…The results of the study carried out by Tambor et al (2014) prove that in the post-communist countries such as Bulgaria, Romania and Ukraine, the payments for the medical services are significantly more widespread, as compared to Hungary and Poland, where they are lower as compared to Lithuania. The patients are looking for coping strategies and borrow money or sell their assets in order to cover these expenditures, their percentage being higher among those with a poorer health condition, those with chronic diseases and with a lower income.…”

The incidence of high medical expenses by health status in seven developed countries

“…When high, OOP requirements can cause some to meet their health care needs only by sacrificing other essential purchases, such as on food, shelter and education. They may also require some to assume debt or liquidate assets intended for other purposes [8,9]. Not surprisingly, such ways of coping with high OOP requirements have been found to be more common among those in poor health and with chronic health problems [9,10].…”

“…Most importantly, though, paying for health care out-of-pocket can deter individuals from medical care, pharmaceutical products, and other needed medical goods [9,[11][12][13][14][15][16][17]. The poor [12,17], elderly [17], and those with health problems [9,18] have been shown to be the most sensitive to cost-sharing requirements.…”

“…The poor [12,17], elderly [17], and those with health problems [9,18] have been shown to be the most sensitive to cost-sharing requirements. Moreover, not only is cost-sharing linked to the reduced use of medical services and weaker adherence to medication therapies, it has also been associated with poorer health outcomes [11,17,19].…”