35
Getting Better? In Search of Convergence
FIGURE 1.3
More Backward Steps than Forward Steps on Financial Protection
OOP payments as % of total health spending
100
80 AZB GEO 60
TAJ ARM ALB
MOL BUL 40
UZB
TKMUKRKAZ SRB BOS KYR
MAC RUS MON LIT SVK HUN LAT BEL EST POL ROM
20
EU-15TUR 0
CZR
SVN
CRO
Countries Decline since 1997
Increase since 1997
Source: WHO 2012. Note: Figure shows changes in share of out-of-pocket payments, 1997–2010. OOP = out of pocket.
many countries have witnessed a rise in OOP spending as compared to a fall, and twice as many have had an increase of at least 10 percentage points compared to those with an equivalent fall. Bosnia and Herzegovina, Latvia, Romania, and Turkey show the most favorable trends. The sharpest increases in OOP reliance are observed in Bulgaria, Moldova, Russia, Serbia, and the Slovak Republic. In other countries, such as Albania, Tajikistan, and the three countries of the south Caucasus, OOP spending remains persistently high. Of course, the objective of financial protection is not to lower outof-pocket payments to zero. But it is noteworthy that OOP payments account for a steady 15–20 percent of total health expenditure in the EU-15, a number broadly consistent with old and new theories on the economic rationale of health financing. About half of ECA is over twice that level. All told, financial protection remains an important issue—either because of persistently high levels or a sharply deteriorating trend—in a little under half of ECA countries. In brief, these are the places where convergence remains elusive. The other side of the health financing equation is the efficiency of the government health budget, the third major health system
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