Abstract
IntroductionMany countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a “traditional” approach. The Eastern European high-income countries studied in this paper managed to avoid this potential pitfall by using state budget revenues to explicitly pay health insurance contributions on behalf of certain (vulnerable) population groups who have difficulties to pay these contributions themselves.The institutional design aspects of their government revenue transfer arrangements are analysed, as well as their impact on universal health coverage progress.MethodsThis regional study is based on literature review and review of databases for the performance assessment. The analytical framework focuses on the following institutional design features: rules on eligibility for contribution exemption, financing and pooling arrangements, and purchasing arrangements and benefit package design.ResultsMore commonalities than differences can be identified across countries: a broad range of groups eligible for exemption from payment of health insurance contributions, full state contributions on behalf of the exempted groups, mostly mandatory participation, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. In terms of performance, all countries have high total population coverage rates, but there are still challenges regarding financial protection and access to and utilization of health care services, especially for low income people.ConclusionOverall, government revenue transfer arrangements to exempt vulnerable groups from contributions are one option to progress towards universal health coverage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0295-y) contains supplementary material, which is available to authorized users.
Highlights
Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a “traditional” approach
Several countries from Central and Eastern Europe and the former Soviet Union moved from a government financed and provided health system (Semashko model) to social health insurance (SHI) and introduced payroll taxes in the early 1990s [1]
The countries covered in this paper mostly managed to avoid this potential pitfall as they transitioned to a contributory health insurance system [3]
Summary
Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a “traditional” approach. An increasing number of governments across the globe decide to use general government revenues, i.e. state budget transfers, to explicitly pay the contributions on behalf of non-contributing population groups, most often in addition to cross-subsidization from within the fund’s contribution, because they realised that progress towards universal health coverage (UHC) is not possible via payroll taxes of contributors only This arrangement is frequently captured and termed as government subsidization of insurance contributions, usually for economically inactive, vulnerable and poor population groups depending on the context [3,4,5,6,7]. Vulnerable groups can be defined as “groups whose demographic, geographic, or economic characteristics impede or prevent their access to health care services” ([8], p. 253)
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