Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Kyriopoulos, Ilias; Nikoloski, Zlatko; Mossialos, Elias
• Is Part Of: Health policy. Volume 125:Issue 9(2021)
• Page Start: 1256
• Page End: 1266
• Publication Date: 2021-09
• Subjects: Financial protection -- Catastrophic health payments -- Cost-sharing -- Health coverage -- User charges -- Greece; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2021.05.010
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Incidence and intensity of catastrophic health expenditure (CHE) substantially increased among older households during 2007–2015. People with chronic conditions and low-income were disproportionately affected. Prior to the crisis, CHE was mainly due to inpatient care. The contribution of spending for outpatient medicines to CHE substantially increased in the study period. Households of low socioeconomic status were more likely to incur CHE in 2015. Abstract: Since the late 2000s, the Greek economy has entered a long period of recession, with reforms and retrenchment in health care being among the main public policy priorities. This study investigates the extent to which financial protection in health has changed among older households during the Greek crisis. We focus on the middle-aged and elderly, the heavy users of health services, who have faced a substantial health and financial burden during the crisis. Our analysis shows that the headcount and overshoot of catastrophic health expenditure (CHE) substantially increased from 2007 to 2015, suggesting that financial protection has eroded to a great extent. Prior to the crisis, CHE was mainly due to inpatient care, followed by outpatient care and medicines. However, the contribution of spending for outpatient medicines to CHE substantially increased during the study period. The headcount of CHE rose across all socioeconomic groups we examined, with low-income households and households with chronic patients being disproportionately affected. In 2007, we do not report signs of socioeconomic inequalities in the risk of CHE. On the contrary, our results show that households of low socioeconomic status are more likely to incur CHE in 2015, revealing substantial inequalities in the risk of CHE. This finding raises significant distributional and equity concerns. Strengthening financial protection among older households is an imperative challenge for the Greek health system, and several policy responses need to be adopted towards this direction.