Abstract

BackgroundThe current health system reforms in Kosovo aim to improve health status through universal health coverage. Risk pooling and ensuring access to necessary care without financial hardship are envisaged through compulsory health insurance. We measure the level of financial risk protection through two commonly applied concepts: catastrophic health expenditures and impoverishment.MethodsData from the 2014 Kosovo Household Budget Survey were used to estimate catastrophic health expenditures as a percentage of household consumption expenditures at different thresholds. Poverty head counts and gaps were estimated before and after out-of-pocket (OOP) health payments.ResultsApproximately 80% of the households in Kosovo incurred OOP health payments. Most of these expenditures were for medicine, pharmaceutical products and medical devices, followed by diagnostic and outpatient services. Hospital services and treatment abroad were less frequent but highly costly. Although households from the upper consumption groups spent more, households from the lower consumption groups spent a greater share of their consumption expenditures on healthcare. The catastrophic health expenditure head count showed an increase, while the impoverishment and poverty gap remained stable compared to 2011. Regression analysis showed that age of the household head, insurance coverage, household size, belonging to the lowest consumption expenditure quintiles, and having disabled and aged household members were significant predictors of the probability of experiencing catastrophic health expenditures.ConclusionsOngoing financing reforms should target the lower income quintiles and vulnerable groups, pharmaceutical policies should be revisited, and the internal referral system should be strengthened to overcome excessive spending for treatment abroad.

Highlights

  • The current health system reforms in Kosovo aim to improve health status through universal health coverage

  • The level of financial protection from out-of-pocket (OOP) health payments is estimated through two statistical parameters: (i) the proportion of a country’s population that has a high share of OOP spending for healthcare, which is considered a substantial financial burden on household budgets and is defined as Arenliu Qosaj et al Cost Eff Resour Alloc (2018) 16:26 catastrophic expenditures; and (ii) the proportion of the population that falls below the poverty line due to OOP health spending, which is defined as impoverishment

  • Construction of statistical parameters Using the World Bank (WB) methodology presented by O’Donnell et al in 2008, we assess financial risk protection by estimating OOP health payments, and we present the consequences as (i) catastrophic health expenditures once they exceed a certain share of the household’s expenditures; (ii) impoverishing health expenditures once they are high enough to push a household below the poverty line and increase the poverty head count; and (iii) the poverty gap, which is the amount needed to push a household up to the poverty line and financially protect it from the consequences of its OOP health payments [6]

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Summary

Introduction

The current health system reforms in Kosovo aim to improve health status through universal health coverage. We measure the level of financial risk protection through two commonly applied concepts: catastrophic health expenditures and impoverishment. Universal health coverage (UHC) means ensuring that everyone, everywhere can obtain quality health services without financial hardship. SDG #3 aims to ensure healthy lives and to promote well-being for people of all ages through UHC, which can be monitored by measuring access to essential quality health services and the level of financial risk protection [2]. Governments, the World Bank (WB), the World Health Organization (WHO) and civil society organizations have recognized that ensuring access to health services for everyone without causing financial hardship is crucial to sustainable economic growth and development. Closely monitoring the progress toward these goals can support evidence-based policy decisions and enrich the global knowledge regarding the approaches to achieving UHC despite severely limited resources

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