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Table 5 OOP expenditure and access to/utilization of health care services

From: State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European Region

Country (Year of introduction of government budget transfers)

OOP as % of THE (2013) [15]

Change of OOP as % of THE since the introduction of government revenue transfers [15]

OOP as a share of household expenditure by income quintile (or otherwise indicated)

Utilization of health care services

Albania (1995)

51 %

29 % decrease

2005: 1st quintile: 8 % - 5th quintile: 4 % [18]

n/a

Bosnia & Herzegovina (Federation (1997) and Republika Srpska (1999))

29 %

27 % decrease since introduction in Republika Srpska

2004: 1st quintile: 2.3 % - 5th quintile: 1.2 % [18]

n/a

Bulgaria (1998)

40 %

10 % increase

the proportionally highest burden of OOPS falls on the low-and middle income groups [38]

n/a

Georgia (MIP)(2006)

62 %

10 % decrease

MIP beneficiaries pay approx. 40–60 % less than non- beneficiaries for outpatient care in the two regions Adjara and Tbilisi and for inpatient care in all regions (2009) [21]

MIP has no impact on utilization rates (data for 2009 and 2010) [21, 89]

Kyrgyzstan (1997)

36 %

11 % decrease

2003: 1st quintile: 7.1 % - 5th quintile: 4.5 %

2009: 1st quintile: 4.4 % - 5th quintile: 4.0 % [30]

utilization of primary care among the poorest quintile increased slightly from 6.3 % in 2001 to 8.1 % in 2009 [30]

Lithuania (1997)

33 %

9 % increase

n/a

n/a

Montenegro (1993)

43 %

13 % increase (since 1995)a

2004: 1st quintile: 0.8 % - 5th quintile: 1.1 % [18]

n/a

Republic of Moldova (2004)

45 %

5 % increase

2008: 1st quintile: 2.8 % - 5th quintile: 7.8 %

2009: 1st quintile: 4.1 % - 5th quintile: 11.4 %

2010: 1st quintile: 3.6 % - 5th quintile: 7.4 % [49]

The uninsured are 3.8 times more like to have had OOP for outpatient care compared to the insured (in 2012); but nearly 0.5 times for inpatient care [39])

11.2 % of the poorest quintile has consulted a doctor in the past four months compared to 25.5 % of respondents from the richest quintile (2010)

Share of exempt population seeking health care in the last 4 weeks: 35.5 % (2008) and 41.7 % (2010) [49]

Romania (1999)

20 %

0 %

n/a

n/a

Russian Federation (1993)

48 %

31 % increase (since 1995)a

n/a

People of higher income quintiles consume medical services more frequently than those of lower quintiles, although the latter’s health outcomes are worse (no year indicated) [27]

Serbia (1992)

38 %

12 % increase (since 1995)a

2003: 1st quintile: 4.4 % - 5th quintile: 3.6 % [18]

n/a

TFYR Macedonia (1991)

31 %

9 % decrease (since 1995)a

n/a

n/a

Turkey (Green Card Scheme) (1992)

15 %

15 % decrease (since 1995)a

Green Card holders: estimated at 4.1 % (2003), 3.5 % (2006), 4.1 % (2009) [90]

OOPs as a share of household consumption expenditure increased for low income groups, but decreased for higher income levels over 2003 to 2006 [91]

Green Card Program associated with a positive and significant impact on protecting health care utilization of the poor during the outbreak of the financial crisis.

22.4 % of the Green Card holders reported forgone use of healthcare services during the last 12 months because of financial barriers, compared to 6.1 % of rest of public insurees [56, 88, 90]

  1. a Introduction of the scheme occurred prior to 1995. National Health Accounts data is available from 1995 onwards