Patterns in out-of-pocket expenses due to healthcare in EU-27 countries (2000-2022)

Abstract Introduction Out-of-pocket expenses (OOPs) are a major determinant of access to different types of health services. According to the current literature, population segments with decreased socioeconomic status are most affected by OOPs, which lead to catastrophic household expenses and increase poverty rates. This study assessed the trends in out-of-pocket expenses due to healthcare in the 27 EU countries. Methods We retrieved “OOPs per capita in US$”, a financing source indicator, from the WHO Global Health Expenditure Database - for 27 EU countries, between 2000 and 2022. We report absolute differences taking the highest and lowest value for each country within the following timeframes: 2000 - 2006, 2007 - 2012, 2013 - 2019, and 2020 - 2022. We conducted four k-means cluster analyses using the obtained differences with R v4.3.3. Results With the exception of Malta, all countries had the highest absolute differences during the first timeline. The lowest differences were found for Romania ($44.6, 2000-2006; $30.52, 2007-2012), Poland ($22.42, 2013-2019), and Croatia ($15.72, 2020-2022), while the highest were observed for Greece ($418.8, 2000-2006; $321.66; 2007-2012), Malta ($363.65, 2013-2019) and Belgium ($199.01, 2020-2022). For the first (2000-2006) and third (2013-2019) timelines, three clusters were identified, while for the second (2007-2012) and forth (2020-2022), four clusters were identified, with cluster means ranging between 95.43 and 349.01 (2000-2006), 45.46 and 290.82 (2007-2012), 54.76 and 363.65 (2013-2019), 49.01 and 199.01 (2020-2022). Conclusions Absolute differences in OOPs among the four timelines for the EU-27 countries are highly variable, which might be due to economic, political and health-related crises. This variability might be explained by differences in type of healthcare systems (in terms of delivery, accessibility, and insurance) and national distributions of socioeconomic levels. Key messages • There is increased variability in OOPs across EU-27 during the period analyzed (2000-2022). • As OOPs can greatly influence population access to health and care services, countries should invest efforts toward minimizing their levels, as well as their impact on population health.