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Getting Better: Improving Health System Outcomes in Europe and Central Asia
More Public Spending Is Sometimes Needed to Improve Financial Protection The ratio of government health spending to gross domestic product (GDP) is an important determinant of the share of total health expenditures financed out of pocket. The first panel of figure 4.6 shows the strong association between these two indicators across the region based on 2010 data. That association also holds true at the global level. Additional public resources for health have been identified as a key pillar in worldwide efforts to achieve universal coverage (WHO 2010). As shown in the previous section, overall reliance on OOP spending is positively correlated with the incidence of catastrophic health expenditures and inequality of utilization. Figures 4.6 and 4.7 indicate that how much a government spends on health matters a lot for the degree of financial protection achieved by a health system. There is also a link between increased health budgets and lower OOP spending in ECA since 1997, as shown in the second panel in figure 4.6. Large increases in health budgets between 1997 and 2010 resulted in significant declines in OOP spending in Bosnia and Herzegovina and Turkey (Aran and Hentschel 2012), while smaller budgets led to higher OOP spending in countries such as Russia and Turkmenistan. Only the Former Yugoslav Republic of Macedonia lowered its budget and its reliance on OOP payments. Certainly most
FIGURE 4.6
Smaller Government Health Budgets Are Associated with a Greater Reliance on OOP Spending a. OOP spending as % of total health expenditures, 2010
b. Change in OOP spending as % of total health expenditures, 1997–2010
80
20
UZB BUL UKR MOL BOS TMN KAZ KYR MAC SRB RUS LAT MON LIT ROM HUN SVK EST POL BEL TUR CROCZR EU-15
40
20
RUS TMN
10 Percent
60 Percent
MOL
AZB TAJ GEO ARM ALB
0
–10
SVN 0
BULSVK SRB TAJ
BEL ESTUZB AZB HUN CZR KAZ LIT MON SVN ALB UKR CRO EU-15 MAC ARMKYR POL ROM TUR GEO LAT BOS
–20 0
2 4 6 Government health spending as % of GDP
8
−3
−2
−1 0 1 2 Change in government health spending as % of GDP
3
Source: WHO 2012. Note: Figure shows link between government spending and out-of-pocket spending on health care for countries in Europe and Central Asia and the EU-15, 1997–2010. OOP = out of pocket.
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