Do Out-Of-Pockets Undermine Equity in Healthcare Financing? A Comparison of Healthcare Systems in Europe

In order to guarantee equal access to healthcare, it must be funded in an equitable manner to ensure that people are not forced to forgo healthcare and to prevent healthcare from becoming too large a financial burden for patients. This is achieved by ensuring that health care received by the poorest people is subsidised by wealthier people, while also ensuring that patients suffering poor health are not burdened with excessive costs for a given income. In practice, patients are required to cover some of their healthcare costs across all European healthcare systems. Since out-of-pockets are only paid by healthcare consumers, their existence may compromise equity in healthcare financing. In this article, we evaluate how out-of-pockets contribute to vertical and horizontal equity in healthcare financing for people aged 50 and over in Europe. Using concentration indices, we demonstrate that equity in financing is not respected, particularly in healthcare systems where out-of-pockets are the least regulated.