How are countries removing financial barriers to accessing health services in the context of COVID-19?

Cross-Country Analysis


How are countries removing financial barriers to accessing health services in the context of COVID-19?

Households increasingly face financial strain as the COVID-19 outbreak becomes an economic crisis in many countries. If people face concerns about health care affordability, they may delay seeking treatment or be prevented from obtaining the services they need, making the outbreak harder to control.

We describe some of the ways in which countries are removing financial barriers to accessing health services taking examples from the COVID-19 Health System Response Monitor unless otherwise noted. The post draws on a short paper from the WHO Barcelona Office for Health Systems Strengthening on key health financing actions countries can take to reduce the adverse effects of the pandemic.

Suspending all user charges (co-payments), including co-payments for non-COVID-19 health services

Out-of-pocket payments create a financial barrier to access and lead to financial hardship for many people using health services in Europe. A large body of evidence shows that co-payments are not a good instrument for rationing health care: they do not selectively deter ‘unnecessary’ use but reduce the use of all health services, particularly among people with chronic conditions and poorer people.

Ireland has removed user charges for remote primary care consultations with people who may have COVID-19. Belgium has initiated teleconsultations in primary care and removed user charges for this new method of service delivery. France has simplified administrative requirements for people with chronic conditions benefiting from co-payment exemptions. Estonia has drawn on private facilities to increase access to testing that is free from co-payments. In North Macedonia, emergency regulation enables the health insurance fund to contract private facilities with intensive care unit capacity and ensure these services are provided without co-payments.

Extending entitlement to publicly financed health services to everyone, regardless of residence or insurance status

Two groups of people are at high risk of being excluded from coverage or only having access to a limited range of services. In most health systems, undocumented migrantsrefugees, asylum seekers and other non-residents are not entitled or have only limited entitlement to publicly financed health services. In health systems that link entitlement to payment of contributions, many people may not be able to afford to pay contributions, particularly those working in the informal economy, self-employed people, people in non-stable work and unemployed people.

Portugal has granted entitlement to publicly financed health services to any migrant or asylum seeker who had applied for residence by mid-March 2020. France is automatically extending entitlement for already-covered migrants during the pandemic. Belgium has extended free access to health services to undocumented migrants for a limited period. Croatia has taken steps to maintain coverage for people who are unable to pay contributions. In Greece and Slovenia, the government will temporarily pay contributions on behalf of self-employed people. Hungary has reduced health insurance contributions for employees in heavily affected sectors. Belgium is allowing self-employed people to request a one-year deferral of health insurance contributions.

Providing people with income support (multi-purpose cash transfers)

Income support is vital to enable people to stay at home; ensure they can pay for food and other basic needs; and help alleviate the indirect costs of seeking health care, such as transport costs and lost labour time. Many countries in Europe have introduced new income support measures, increased public spending on existing programmes, lifted or simplified administrative requirements and introduced complementary measures to protect people – for example, the deferral of rent, mortgage and loan payments.

Health and economic shocks do not affect everyone equally

Some people are systematically more likely than others to experience financial barriers to access, including migrants, people living in poverty, those who have lost work and people in informal or non-stable work. A number of countries in Europe have moved swiftly to reduce barriers by identifying and supporting the people most in need.

Sarah Thomson, Triin Habicht, Tamás Evetovits