Irish Findings on Financial Protection

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Herbert Tucker
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1 Irish Findings on Financial Protection Bridget Johnston Mapping the Pathways to Universal Healthcare Centre for Health Policy and Management, Trinity College Dublin 22 September 2015

2 Measuring Financial Protection USING THE NEW WHO APPROACH

3 Methodology WHO methodology - allows cross country comparisons Household Budget Survey th quarter rd quarter 2010 CSO Representative sample with 5,891 households Currently out in the field, will update as soon as possible (Spring 2016) On 1 Jan 2010: 50 cent prescription charge introduced for medical card holders Drug payment scheme up from 100 to 120

Currently out in the field, will update as soon as possible (Spring 2016) On 1 Jan 2010: 50

4 Methodology Out of Pocket costs Drugs, other medical products and equipment, outpatient, dental, diagnostic tests and paramedical services and inpatient fees Poverty line Housing consumption expenditures added to food-based poverty line Equivalised poverty line = Subsistence expenditure level (Mean = ) Households classified as poor if expenditure<subsistence expenditure (1.84%) Capacity to pay (CTP) Expenditure beyond household subsistence expenditure (mean = )

Equivalised poverty line = 120.53 Subsistence expenditure level (Mean = 171.

5 Out-of-pocket spending as a share (%) of total household consumption by expenditure quintile, Total

6 Breakdown of total out-of-pocket spending by type of health service and expenditure quintile, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total Inpatient Diagnostic tests and other paramedical services Dental Outpatient Other medical products and equipment Drugs

20% 10% 0% 1 2 3 4 5 Total Inpatient Diagnostic tests and other

7 Share of the population (%) experiencing catastrophic and impoverishing health spending, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1.07% 2009 No OOP spending Not at risk of impoverishment from OOPs At risk of impoverishment from OOPs Impoverished by OOPs Further impoverished by OOPs All types of catastrophic spending (40% of CTP)

07% 2009 No OOP spending Not at risk of impoverishment from OOPs At risk of

8 Absolute numbers of people affected, Category Total number 95% Confidence Intervals Further impoverished by OOPs 24,761 11,753 37,770 Impoverished by OOPs 3,759-2,473 9,990 At risk of impoverishment from OOPs 34,739 20,721 48,757 No risk 2,671,025 2,573,210 2,768,839 No OOP 1,328,208 1,259,846 1,396,569 Catastrophic spending (40% of CTP) 47,592 34,879 60,304

9,990 At risk of impoverishment from OOPs 34,739 20,721 48,757 No risk 2,671,025 2,573,210

9 Proportion experiencing catastrophic, impoverishing and further impoverishing OOPs by expenditure quintile, % 4.0% 3.83% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 0.43% 0.48% 0.48% 0.13%

quintile, 2009-2010 4.5% 4.0% 3.83% 3.5% 3.0% 2.

10 Out-of-pocket spending by households experiencing catastrophic, impoverishing, or further impoverishing OOPs by type of health service and expenditure quintile 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Inpatient Diagnostic tests and other paramedical services Dental Outpatient Other medical products and equipment Drugs 0% Total

90% 80% 70% 60% 50% 40% 30% 20% 10% Inpatient Diagnostic tests and other paramedical

11 Summary of Results The findings suggest OOPs are largely for goods and services not normally covered by a medical card or GP visit card Patterns of spending vary across expenditure quintiles Caution is needed when interpreting results Will not capture unmet need Data was collected in so does not capture any of the policy changes that have occurred since then

quintiles Caution is needed when interpreting results Will not capture unmet need Data was

12 The Role of Private Health Insurance How well does PHI financially protect people from catastrophic spending? New WHO threshold: 17% of households with catastrophic spending were also paying for PHI 60% of equivalised expenditure: 30% of households with catastrophic spending were also paying for PHI Does not cover many out of pocket payments Less related to household income than OOPs Is PHI affordable? What impact does paying for it have on households?

expenditure: 30% of households with catastrophic spending were also paying for PHI Does not cover many out of

13 Measuring Affordability NATIONAL POVERTY LINE AND PRIVATE HEALTH EXPENDITURE

14 Methods Private health expenditure Out-of-pocket costs Private Health Insurance Poverty line 60% of median equivalised household expenditure Poverty line = Subsistence expenditure (Mean = ) Households classified as poor if expenditure<subsistence expenditure (18.46%) Capacity to pay (CTP) Expenditure beyond household subsistence expenditure (mean = )

15 Private health expenditure as a share of total household expenditure by expenditure quintile, Total

expenditure quintile, 2009-2010 6 5.75 5.

16 Distribution of total private health expenditure by type of health service and expenditure quintile, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total Insurance Inpatient Diagnostic and laboratory tests Dental Outpatient fees GP fees Other goods and services OTC drugs Prescribed Drugs

0% 1 2 3 4 5 Total Insurance Inpatient Diagnostic and laboratory tests

17 Households private health expenditure and capacity to pay, % No PHE 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 15.42% 2009 No risk of PHE exceeding CTP At risk of PHE exceeding CTP PHE exceeding CTP Negative CTP for PHE Unaffordable PHE - negative CTP, exceeding CTP or spending more than 40% of CTP

42% 2009 No risk of PHE exceeding CTP At risk of PHE exceeding CTP PHE

18 Paying for Private Health Insurance - At any cost? 29% of households with negative capacity to pay were paying for private health insurance 80% of households with private health expenditure exceeding capacity to pay were paying for private health insurance 31% of households at risk of private health expenditure exceeding capacity to pay were paying for private health insurance 50% of households with unaffordable private health expenditure were paying for private health insurance

health expenditure exceeding capacity to pay were paying for private health insurance 31% of households at risk of

19 Absolute numbers of people affected, Category Total number 95% Confidence Intervals Negative CTP for PHE 428, , ,161 PHE exceeding CTP 82,234 60, ,019 At risk of PHE exceeding CTP 327, , ,364 No risk of PHE exceeding CTP 2,358,173 2,271,004 2,445,342 No PHE 866, , ,001 Unaffordable PHE 701, , ,493

104,019 At risk of PHE exceeding CTP 327,232 284,099 370,364 No risk of PHE exceeding CTP

20 Share of the households experiencing unaffordable PHE by expenditure quintile, % 50% 47.78% 40% 30% 20% 18.68% 10% 0% 6.63% 2.72% 1.29%

21 Breakdown of spending by households with unaffordable PHE by type of health service and expenditure quintile, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total Private Health Insurance Inpatient Laboratory and diagnostic services Dental Outpatient GP Other goods and equipment OTC drugs Prescribed drugs

22 Absolute numbers with unaffordable PHE who have private health insurance costs by expenditure quintile, Quintile Absolute Numbers 1 129, , , , ,668

23 In summary Overall, the most significant proportion of spending for households with unaffordable private health expenditure went towards PHI. Lowest consumption quintile disproportionately affected More than 50% of households with unaffordable private health expenditure are paying for private health insurance

24 Thank You

Medical Insurance for the Poor: impact on access and affordability of health services in Georgia

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