Methods

Financial protection means access to health care is affordable for everyone: no one experiences unmet need or financial hardship due to out-of-pocket payments.

Lack of financial protection deepens poverty, erodes health and well-being and increases inequality.

Affordable access to health care is central to universal health coverage (UHC). Countries in Europe and central Asia have committed to UHC through the Tallinn Charter (2008), the Sustainable Development Goals (2015), the European Pillar of Social Rights (2017) and WHO’s European Programme of Work (2020).

Financial hardship is measured using indicators of impoverishing and catastrophic health spending derived from national household budget surveys.

These indicators can be calculated in different ways. We use metrics developed by WHO/Europe, building on earlier metrics (Wagstaff & van Doorslaer, 2003; Xu et al., 2003). We do not use the global measure of catastrophic health spending – original SDG indicator 3.8.2 – because it does not adequately capture equity (WHO & World Bank, 2017; Cylus et al., 2018; Thomson et al., 2019; WHO Regional Office for Europe, 2019; Cylus et al., 2024).

For more detailed information, see our briefing for Member States (English, Russian and methods guide (English, Russian).

Contact us if you would like to use our statistical codes.

We monitor unmet need using data from EU Statistics on Income and Living Standards (EU-SILC) and the European Health Interview Survey (EHIS).

These surveys ask people if there was a time in the last year when they needed health care but were not able to access it due to cost, distance or waiting time (health system factors).

Internationally comparable data on unmet need for health care, dental care, mental health care and prescribed medicines are available for EU Member States and a few other countries.

We monitor coverage policy – the way in which health coverage is designed and implemented – through the UHC Watch Network.

Coverage policy is a key determinant of the level and distribution of out-of-pocket payments in a country.

National experts in the network provide systematic information on population coverage, service coverage, user charges (co-payments), voluntary health insurance, gaps in coverage and changes in coverage policy over time using a template. This information is edited by the WHO Barcelona Office team and updated by experts at least once a year.

We monitor spending on health using internationally comparable health accounts data from the WHO Global Health Expenditure Database, OECD.Stat and Eurostat.

These data are prepared using the System of Health Accounts 2011, which allows health system financial flows to be tracked systematically.

Health accounts data provide information on how much countries spend on health, how much comes from government and households, and how much is channelled through compulsory and voluntary health financing arrangements.