title: Detecting changes in financial protection: creating evidence for policy in Estonia.
abstract: Ninety-four per cent of the Estonian population is covered by public health insurance, but private expenditure has been increasing quickly both in real terms and as a percentage of total health expenditure. To date, little attention has been given to the impact this could have on the population's financial protection. Out-of-pocket payments, which account for the bulk of the private expenditure in many low- and middle-income countries, can push people into poverty and more generally represent too high a burden for some households. It is therefore very important that governments monitor the impact of out-of-pocket payments on health. Using an example from Estonia, this paper aims to illustrate that, if household budget survey data are available, monitoring a population's financial protection is not a complex undertaking. Further, by combining simple statistical analyses of these data with a good knowledge of a country's health system, it is possible to give a fairly detailed diagnostic of the nature of the population's coverage limitation. This allows for the presentation of easily interpretable results that can raise awareness among policy-makers and help to target adequate policy responses. Using Estonian household budget surveys from 1995, 2001 and 2002, we show that the proportion of households who spend more than 20% of their capacity to pay on health increased from 3.4% in 1995 to 7.4% in 2002 and that in 2002, 1.3% of the population fell into poverty because of health payments. Logistic regression helps in identifying the population most at risk: elderly patients who belong to poor households and spend high amounts on medicines. This study, which can be replicated, did raise awareness among policy-makers about the changes in financial protection over the years in Estonia.
authors.affiliation: World Health Organization Country Office in Estonia, WHO Regional Office for Europe, Tallinn, Estonia. jha@who.org.ee
authors.forename: Jarno
authors.initials: J
authors.lastname: Habicht
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Agnes
authors.initials: A
authors.lastname: Couffinhal
authors.forename: Joseph
authors.initials: J
authors.lastname: Kutzin
mesh_terms: D003625:Data Collection; D003695:Delivery of Health Care / Q000458:organization & administration; D004957:Estonia; D005382:Financing, Personal / Q000706:statistics & numerical data*; D007348:Insurance, Health; D011050:Policy Making; D017149:Private Sector; D011634:Public Health; D012923:Social Class; D019472:Universal Health Insurance