Can people afford to pay for health care? New evidence on financial protection in Ukraine

ABSTRACT

Out-of-pocket payments account for a very high share of total spending on health in Ukraine. Their share has grown substantially in recent years, as the share of the Government budget allocated to health has fluctuated but fallen overall, reaching a low of 8.6% in 2015; this is below the average of 10.2% for lower middle-income countries and far below the EU average of 13.5% and the European Region average of 12.5%.Inefficiencies and inequities in the way in which these very limited public resources are allocated and used in the health system exacerbate access barriers and financial hardship, particularly for medicines and inpatient care, the two types of health care responsible for almost all catastrophic spending. Financial protection could be improved by addressing these inefficiencies and using any savings gained to enhance coverage for those most in need of protection – poor people and people with chronic conditions. The increase in the incidence of catastrophic spending on health seen in Ukraine between 2013 and 2015 is partly the result of factors beyond the health system – growing poverty and a substantial decline in living standards. Catastrophic and impoverishing out-of-pocket payments are concentrated among the poorest quintile. National statistics indicate that households living in rural areas, households with three or more children and those in which all members are retired are most affected by poverty and, consequently, should be prioritized for enhanced protection. This review is part of a series of country-based studies generating new evidence on financial protection in European health systems.