Health care utilisation in Estonia: socioeconomic determinants and financial burden of out-of-pocket payments
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2010-06-16T11:26:49Z
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Abstract
Käesolev uuring annab esmakordse ülevaate tervishoiuteenuste kasutamise mustritest, sotsiaal-majanduslikest erinevustest teenuste kasutamisel, omaosaluse osatähtsusest leibkonna kuludes ja omaosalusest tingitud finantskoormustest Eesti tervishoius.
Sotsiaal-majanduslikke erinevusi tervises on täheldatud paljudes Euroopa riikides. On leitud, et kvaliteetsete tervishoiuteenuste vähene kättesaadavus moodustab ühe osa madalama sotsiaal-majandusliku staatuse ja halva tervise vahelises põhjuslikust ahelast. Selleks, et hinnata ebavõrdsust tervishoiuteenuste kättesaadavuses on pakutud välja mitmeid definitsioone, milles enamasti analüüsitakse võrdset teenuste kasutamist võrdse vajaduse korral. Ebavõrdseks loetakse olukorda, kus pärast tervisevajaduste arvestamist saavad kõrgema sotsiaal-majandusliku staatusega isikud suurema tõenäosusega kasutada tervishoiuteenuseid või kasutavad tervishoiuteenuseid rohkem. Üks tervisesüsteemi eesmärkidest on jaotada rahastamiskoormus õiglaselt, lähtudes maksevõimest ning eesmärgist, et inimesed ja leibkonnad ei vaesuks haiguse või arstiabi kasutamise tulemusena. Seega vajavad omaette analüüsi ja tähelepanu sellised rahalised barjäärid nagu omaosalus tervishoiuteenuste kasutamisel.
Käesoleva töö eesmärk oli analüüsida tervishoiuteenuste kasutamist Eestis, hinnates arstiabi kättesaadavust, sotsiaal-majanduslike tegurite mõju ja oma¬osalusest tingitud finantskoormust.
Käesolevas uurimistöös on kasutatud 1999. aastal Eestis, Lätis ja Leedus läbiviidud läbilõikelist uuringut Norbalt ja sama metoodika alusel aastatel 1995, 2001 ja 2002 läbiviidud Eesti leibkonna eelarve uuringuid. Tervishoiuteenuste kasutamist on analüüsitud Eestis telefonikonsultatsioonide, esmatasandi visiitide, hambaarsti külastuste, ambulatoorse eriarstiabi visiitide ja hospitaliseerimiste lõikes. Samuti on võrreldud tervishoiuteenuste kasutamist kolmes riigis. Omaosaluse analüüsil on kirjeldatud leibkondade poolt tervishoiule tehtavate kulutuste suurust ja jaotust leibkonna sissetuleku lõikes. Lisaks on kirjeldatud eri tervishoiuteenustele tehtavaid kulutusi viimastel aastatel ning seejärel on analüüsitud finantskaitset.
Pärast 1990. aastate alguse ulatuslikke reforme on Eestis arstiabi kättesaadavus ja finantskaitse võrreldav teiste ELi ja OECD riikidega. Eesti olukord on parem kui teiste Balti riikide, eriti Läti oma. Sotsiaal-majanduslikud erinevused arstiabi kasutamises ilmnevad seoses isikute sissetuleku, hariduse ja staatusega tööturul. Samuti on teenuste kasutamises piirkondlikke erinevusi. Ebavõrdsus, mis väljendub kõrgema sotsiaalse staatusega isikute soosimises, esineb telefonikonsultatsioonide, ambulatoorse eriarstiabi visiitide ja hambaarsti külastuste puhul. Eesti tervishoiu rahastamissüsteem pakub üldjoontes adekvaatset finantskaitset suuremale osale rahvastikust. Samas näitavad uuringu tulemused finantskaitse vähenemist läbi aja ja eelkõige vaesemate leibkondade hulgas. Uuringus tuleb selgelt välja, et omaosalus on oluline barjäär arstiabi kasutamisel, seda eriti retseptiravimite ja hambaravi puhul. Omaosaluse vähendamiseks tuleks kehtestada omaosaluse erandid madalama sissetuleku ja suurema tervisevajadusega inimestele.
The current study provides first evidence on the utilisation patterns of health care, the socioeconomic inequalities in health services use, distribution of out-of-pocket payments in household expenditures and the financial burden incurred from cost-sharing arrangements in health care in Estonia. Socioeconomic inequalities in health have been found in all the observed European countries. Further previous studies have found evidence that lack of access to good quality health care is part of a causal chain leading from low socioeconomic status to poor health. To evaluate inequalities in access to health care several working definitions for policymakers are proposed, while in most cases equal utilization for equal need is analysed. Inequity is assumed to arise when individuals in higher socioeconomic groups are more likely to use or are using more health services after controlling for their level of need. One of the objectives of any health system should be to distribute the funding burden fairly according to the ability to pay, so that individuals and families do not become impoverished as a consequence of illness or use of health services. Thus financial barriers such as out-of-pocket payment need to be analysed and well-managed in policy decisions. The objective of this study was to generate new knowledge of patterns of health care services utilisation, access to care, socioeconomic inequalities, and the health-system provided financial protection in relation to out-of-pocket payments, with particular focus on Estonia. The current study is based on the analysis of the cross-sectional surveys and provides original results complementing the 1999 household interview survey Norbalt of Estonia, Latvia and Lithuania and the 1995, 2001 and 2002 household budget surveys in Estonia. Services utilisation was analysed in Estonia for telephone consultations, visits to general practitioner, visits to specialists, visits to dentists, and hospitalisation. Further comparison of health care service utilisation in three countries is provided. The size of out-of-pocket payments and distribution over household income distribution is described. Further the out-of-pocket payments allocation to different health care services in recent years is analysed together with financial protection provided by the health system. After extensive health reforms since early 1990s, the situation in Estonia in terms of access to care and financial protection is comparable to that of other EU and OECD countries. Estonia’s situation seems to be more favourable that those of the Baltic neighbours, especially Latvia. The socioeconomic inequalities in service use exist by income, education and employment status, and geographical variation in use is observed. The inequalities were present in telephone consultations, specialist outpatient visits and dental care, in favour of those of higher socioeconomic status. While the health financing system generally provides adequate financial protection to the vast majority of the population, the results show clearly that the financial protection has eroded over the period under consideration, particularly for poorer Estonians. There is sufficient evidence that out-of-pocket payment is a serious access barrier to necessary care, especially prescription medicines and dental care. This calls for the introduction of income- or health-related targeted and means tested copayment exemptions and other policies in the near future.
The current study provides first evidence on the utilisation patterns of health care, the socioeconomic inequalities in health services use, distribution of out-of-pocket payments in household expenditures and the financial burden incurred from cost-sharing arrangements in health care in Estonia. Socioeconomic inequalities in health have been found in all the observed European countries. Further previous studies have found evidence that lack of access to good quality health care is part of a causal chain leading from low socioeconomic status to poor health. To evaluate inequalities in access to health care several working definitions for policymakers are proposed, while in most cases equal utilization for equal need is analysed. Inequity is assumed to arise when individuals in higher socioeconomic groups are more likely to use or are using more health services after controlling for their level of need. One of the objectives of any health system should be to distribute the funding burden fairly according to the ability to pay, so that individuals and families do not become impoverished as a consequence of illness or use of health services. Thus financial barriers such as out-of-pocket payment need to be analysed and well-managed in policy decisions. The objective of this study was to generate new knowledge of patterns of health care services utilisation, access to care, socioeconomic inequalities, and the health-system provided financial protection in relation to out-of-pocket payments, with particular focus on Estonia. The current study is based on the analysis of the cross-sectional surveys and provides original results complementing the 1999 household interview survey Norbalt of Estonia, Latvia and Lithuania and the 1995, 2001 and 2002 household budget surveys in Estonia. Services utilisation was analysed in Estonia for telephone consultations, visits to general practitioner, visits to specialists, visits to dentists, and hospitalisation. Further comparison of health care service utilisation in three countries is provided. The size of out-of-pocket payments and distribution over household income distribution is described. Further the out-of-pocket payments allocation to different health care services in recent years is analysed together with financial protection provided by the health system. After extensive health reforms since early 1990s, the situation in Estonia in terms of access to care and financial protection is comparable to that of other EU and OECD countries. Estonia’s situation seems to be more favourable that those of the Baltic neighbours, especially Latvia. The socioeconomic inequalities in service use exist by income, education and employment status, and geographical variation in use is observed. The inequalities were present in telephone consultations, specialist outpatient visits and dental care, in favour of those of higher socioeconomic status. While the health financing system generally provides adequate financial protection to the vast majority of the population, the results show clearly that the financial protection has eroded over the period under consideration, particularly for poorer Estonians. There is sufficient evidence that out-of-pocket payment is a serious access barrier to necessary care, especially prescription medicines and dental care. This calls for the introduction of income- or health-related targeted and means tested copayment exemptions and other policies in the near future.
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