All countries can move towards universal health coverage by learning from good practice

Authors: Jorge Alejandro García Ramírez (health policy analyst, consultant) and Jon Cylus (senior health economist), WHO Barcelona Office for Health Systems Financing

Picture this: One day you wake up feeling unwell and set up a doctor's appointment. As part of your treatment, you'll need diagnostic tests and medicines. But what if you can't afford them – or have to choose between paying for your medical expenses or heating your home?

This is the reality for many people. Health systems in Europe have committed to universal health coverage (UHC) – ensuring that everyone can access good-quality health care without facing financial hardship. Yet, recent evidence from WHO/Europe shows that this goal is still far from being achieved.

Too many people in Europe pay more than they can afford out-of-pocket for health care, especially for needed medicines. These costs can cause financial hardship, disproportionately affecting those with lower incomes. In Spain, 2.9% of households experienced financial hardship due to out-of-pocket payments in 2020 according to the latest available data. In countries with weak coverage policy design, this figure can be much higher – in Bulgaria, for example, in 2018 19% of households experienced financial hardship due to out-of-pocket payments.

Policy choices matter. All countries can make progress towards universal health coverage by learning from good practice in peer countries. A recent series of WHO/Europe publications on affordable access to health care highlights policy options such as:

• anticipating challenges for the financial sustainability of health systems in the context of population ageing and taking action now to strengthen coverage policy
• understanding the adverse effects of user charges (co-payments) for diabetes medicines;
• reducing the avoidable co-payments caused by reference pricing for outpatient medicines by ensuring people are prescribed and dispensed the lowest-cost alternatives and building trust in generics and biosimilars;
• using income-based caps to protect people from user charges for health care
• using digital solutions to protect people from user charges for health care;
• improving access to mental care for children and adolescents and people with low incomes; and
• increasing the role of primary care health care in addressing mental health conditions and improving the role of community-based mental health care.

Countries can also make use of the growing evidence that is available via the new online platform, UHC Watch, which monitors affordable access to heath care in Europe and Central Asia. UHC Watch aims to support policy-makers to understand how their countries perform on UHC goals and to highlight what they can do to improve. It features the latest evidence on health financing policy in the region, country dedicated analysis, quantitative evidence and policy analysis. To mark UHC Day this year, UHC Watch has launched new regional pages that provide a comparative overview of affordable access to health care in the European Union, the Western Balkans, Eastern Europe and Central Asia and the European Region as a whole.

Strong health financing systems are needed to move towards UHC by protecting people from out-of-pocket payments for health care. The good news is that there is plenty of evidence to support policy choices, guided by good practice from countries in Europe.