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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