Results of a comparative analysis of the dynamics of healthcare expenditure from the GDP of countries, cash payments from families and state expenditures on healthcare in Ukraine, Poland and in the WHO European countries
Keywords:medical care, healthcare, pharmaceutical care, healthcare financing
The aim: to conduct a comparative analysis of the dynamics of health expenditures from GDP, cash expenditures of families and public expenditures on health in Ukraine, Poland and the countries of the WHO European Region.
Materials and methods. The object of the research was the data of the WHO European Office. Historical, analytical-comparative, systemic, logical, graphic, mathematical-statistical and other research methods were used.
Research results. It was found that all indicators of the analysis in Ukraine had an unstable character of changes in the years dynamics. Since 1995, Poland and European countries have seen a systematic increase in total health spending (%) of the country's GDP. The indicator of out-of-pocket expenses of families on medical and pharmaceutical support in Ukraine was significantly higher than in Poland and European countries, and its average values in Ukraine were 1.5 times higher than in Poland. In 2014, this indicator reached its maximum (46.2 %) against the background of an increase in government spending (%) of total health spending (from 11.9 % to 12.7 %). In 2014, this indicator exceeded similar values in Poland by 2.0 times and 1.7 times in European countries. In contrast, in Poland, the out-of-pocket expenses of families on medical and pharmaceutical support have been steadily decreasing from 30.0 % to 22.1 %, and since 2010 they have been lower than in European countries. According to government spending as a percentage of total health spending in Europe and Poland, there was a trend towards a gradual increase from 11.0 % to 13.2 % (European countries) and from 8.2 % to 10.7 % (Poland). The corresponding Ukrainian data were higher than in Poland and lower than in European countries (from 10.8 % to 11.4 %). Against the background of the unstable nature of the dynamics of changes in indicators characterizing the participation of the state in financing health care in Ukraine, since 2005, there has been an increase in the cash expenditures of Ukrainian families for relevant needs. As a result of systemic transformations in Poland, on the threshold of its accession to the EU (May 1, 2004), since 2005, there has been a decrease in the out-of-pocket expenditures of families against the background of a slight increase in % of public spending on health care.
Conclusions. The unstable nature of the dynamics of changes in domestic indicators, in comparison with similar data that was observed in Poland and the countries of the WHO European Region, suggests the need to introduce more decisive actions, which should lead to a reformatting of the role of the state in financing the health system
- Sparkes, S. P., Bump, J. B., Özçelik, E., Kutzin, J., Reich, M. R. (2019). Political Economy Analysis for Health Financing Reform. Health Systems & Reform, 5 (3), 183–194. doi: http://doi.org/10.1080/23288604.2019.1633874
- Campos, P. A., Reich, M. R. (2019). Political analysis for health policy implementation. Health Systems & Reform, 5 (3), 224–235. doi: http://doi.org/10.1080/23288604.2019.1625251
- Jamison, D. T., Lawrence, H. S., George, A., Arrow, K. J., Berkley, S., Binagwaho, A. et. al. (2013). Global health 2035: a world converging within a generation. The Lancet, 382 (9908), 1898–1955. doi: http://doi.org/10.1016/S0140-6736(13)62105-4
- Yuan, B., Jian, W., He, L. Wang, B., Balabanova, D. (2017). The role of health system governance in strengthening the rural health insurance system in China. International Journal for Equity in Health, 16 (44) http://doi.org/10.1186/s12939-017-0542-x
- Schmets, G., Rajan, D., Kadandale, S. (Eds.) (2016). Strategizing national health in the 21st century. Geneva: World Health Organization, 690.
- Hester, J. A., Stange, P. V., Seeff, L. C., Davis, J. B., Craft, C. A. (2015). Towards Sustainable Improvements in Population Health Overview of Community Integration Structures and Emerging Innovations in Financing. Atlanta: CDC Health Policy Series. Available at: https://www.cdc.gov/policy/docs/financepaper.pdf
- Halfon, N., Long, P., Chang, D. I., Hester, J., Inkelas, M., Rodgers, A. (2014). Applying A 3.0 Transformation Framework To Guide Large-Scale Health System Reform. Health Affairs, 33 (11), 2003–2011. doi: http://doi.org/10.1377/hlthaff.2014.0485
- Fukuzawa, D. D. (2013). Achieving Healthy Communities through Community-Centered Health Systems. National Civic Review, 102 (4), 57–60. doi: http://doi.org/10.1002/ncr.21158
- Ievtushenko, O. M., Pestun, I. V., Mnushko, Z. M., Velma, S. V., Osama, A. M. N. A. (2019). Modeling of the effect of socio-economic factors on the accessibility of medical and pharmaceutical care to the population. JGPT, 11 (1), 355–366.
- Nemchenko, A. S., Titko, I. A., Podgaina, M. V., Korzh, Y. V., Zaytzeva, Y. L. (2018). Legal and organizational economic aspects of the functioning of the main models of health-care systems. Asian Journal of Pharmaceutics, 12 (3), 937–945.
- Gilbert, K., Park, K., Capuano, C., Soakai, T. S., Slatyer, B. (2019). Achieving UHC in the Pacific, a Closer Look at Implementation: Summary of a Report for Pacific Health Ministers. Health Systems & Reform, 5 (1), 83–90. doi: http://doi.org/10.1080/23288604.2018.1537874
- Kutzin, J., Witter, S., Jowett, M., Bayarsaikhan, D. (2017). Developing a national health financing strategy: a reference guide. Geneva: World Health Organization; Health Financing Guidance, No. 3.
- Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., Murray, C. J. (2010). Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375 (9723), 1375–1387. doi: http://doi.org/10.1016/s0140-6736(10)60233-4
- Health sector reform issues and opportunities (2000). Regional office for South-East Asia World Health Organization. Available at: https://apps.who.int/iris/bitstream/handle/10665/127574/WP_HlthSecRefm_Final %20Version.pdf;sequence=1
- Reeves, A., Gourtsoyannis, Y., Basu, S., McCoy, D., McKee, M., Stuckler, D. (2015). Financing universal health coverage-effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. The Lancet, 386 (9990), 274–280. doi: http://doi.org/10.1016/s0140-6736(15)60574-8
- Chu, A., Kwon, S., Cowley, P. (2019). Health Financing Reforms for Moving towards Universal Health Coverage in the Western Pacific Region. Health Systems & Reform, 5 (1), 32–47. doi: http://doi.org/10.1080/23288604.2018.1544029
- Reich, M. R., Shibuya, K. (2015). The future of Japan’s health system–sustaining good health with equity at low cost. New England Journal of Medicine, 373 (19), 1793–1797. doi: http://doi.org/10.1056/nejmp1410676
- Cali, J., Makinen, M., Derriennic, Y. (2018). Emerging Lessons from the Development of National Health Financing Strategies in Eight Developing Countries. Health Systems & Reform, 4 (2), 136–145. doi: http://doi.org/10.1080/23288604.2018.1438058
- Korzh, I. V., Romanko, T. A., Zhirova, I. V., Podgaina, M. V., Tereschenko, L. V., Kalaycheva, S. G. (2019). Study of social and Epidemiological Indicators of tuberculosis in the European region. Journal of Advanced Pharmacy Education and Research, 9 (3), 62–67.
- Marcell, A. V., Breuner, C. C., Hammer, L., Hudak, M. L. (2018). Targeted Reforms in Health Care Financing to Improve the Care of Adolescents and Young Adults. Pediatrics, 142 (6), e20182998. doi: http://doi.org/10.1542/peds.2018-2998
- Algado-Sellés, N., Gras-Valentí, P., Chico-Sánchez, P., Mora-Muriel, J. G., Soler-Molina, V. M., Hernández-Maldonado, M. et. al. (2020). Frequency, Associated Risk Factors, and Characteristics of COVID-19 Among Healthcare Personnel in a Spanish Health Department. American Journal of Preventive Medicine, 59 (6), e221–e229. doi: http://doi.org/10.1016/j.amepre.2020.07.014
- Mokrzycka, A., Kowalska-Bobko, I., Sagan, A., Włodarczyk, W. C. (2016). The 2014 primary health care reform in Poland: Short-term fixes instead of a long-term strategy. Health Policy, 120 (11), 1226–1232. doi: http://doi.org/10.1016/j.healthpol.2016.07.012
- Kowalska, I., Sagan, A., Mokrzycka, A., Zabdyr-Jamróz, M. (2015). The first attempt to create a national strategy for reducing waiting times in Poland: Will it succeed? Health Policy, 119 (3), 258–263. doi: http://doi.org/10.1016/j.healthpol.2014.12.010
- Sagan, A., Panteli, D., Borkowski, W., Dmowski, M., Domański, F., Czyżewski, M. et. al. (2011). Poland: health system review. Health Systems in Transition, 13 (8), 193.
- Darvas, Z., Moës, N., Myachenkova, Y., Pichler, D. (2018). The macroeconomic implications of healthcare. Policy Contribution, 11. Available at: https://www.bruegel.org/wp-content/uploads/2018/08/PC-11_2018_cover.pdf
- Culyer, A. J., Newhouse, J. P. (Eds.) (2000). Handbook of health economics. Elsevier, 1000.
- European Health Information Gateway. Available at: https://gateway.euro.who.int/en/
- Fang, J.-Q.; Fang, J.-Q. (Ed.) (2017). Handbook of Medical Statistics. World Scientific, 850.
- Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., Murray, C. J. (2003). Household catastrophic health expenditure: a multicountry analysis. The Lancet, 362 (9378), 111–117. doi: http://doi.org/10.1016/s0140-6736(03)13861-5
- Xu, K., Evans, D. B., Carrin, G., Aguilar-Rivera, A. M., Musgrove, P., Evans, T. (2007). Protecting Households From Catastrophic Health Spending. Health Affairs, 26 (4), 972–983. doi: http://doi.org/10.1377/hlthaff.26.4.972
- Fox, A. M., Reich, M. R. (2015). The Politics of Universal Health Coverage in Low- and Middle-Income Countries: A Framework for Evaluation and Action. Journal of Health Politics, Policy and Law, 40 (5), 1023–1060. doi: http://doi.org/10.1215/03616878-3161198
- Frenk, J., Gómez-Dantés, O., Knaul, F. M. (2019). A dark day for universal health coverage. The Lancet, 393 (10169), 301–303. doi: http://doi.org/10.1016/s0140-6736(19)30118-7
- Richardson, E., Sautenkova, N., Bolokhovets, G. (2015). Access to medicines in the former Soviet Union. Eurohealth incorporating Euro Observer, 21 (2), 10–13.
- Glonti, K. (2015). Challenges in specialised and inpatient services in former soviet countries. Eurohealth incorporating Euro Observer, 21 (2), 7–9.
- Balabanova, D., Roberts, B., Richardson, E., Haerpfer, C., McKee, M. (2011). Health Care Reform in the Former Soviet Union: Beyond the Transition. Health Services Research, 47 (2), 840–864. doi: http://doi.org/10.1111/j.1475-6773.2011.01323.x
- Rechel, B., McKee, M. (2009). Health reform in central and eastern Europe and the former Soviet Union. The Lancet, 374 (9696), 1186–1195. doi: http://doi.org/10.1016/s0140-6736(09)61334-9
- Еvaluation of the affordable medicines programme in Ukraine (2019). Copenhagen: WHO Regional Office for Europe, 56. Available at: https://apps.who.int/iris/bitstream/handle/10665/311229/9789289054003-eng.pdf?sequence=1&isAllowed=y
- Valeria, L., Kaluski, D. N., Elke, J., Erica, R. (2015). Reforming the Ukrainian health system at a time of crisis. Eurohealth incorporating Euro Observer, 21 (2), 14–16.
- Bertone, M., Jowett, M., Dale, E., Witter, S. (2019). Health financing in fragile and conflict-affected settings: what do we know, seven years on? Social Science & Medicine, 232, 202–219. doi: http://doi.org/10.1016/j.socscimed.2019.04.019
How to Cite
Copyright (c) 2021 Анна Леонидовна Панфилова, Анжела Борисовна Ольховская, Любовь Григорьевна Бобошко, Геннадий Николаевич Юрченко, Максим Юрьевич Бандура, Zyro Dominik
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.