Financial protection in Europe: a systematic review of the literature and mapping of data availability

Abstract

BACKGROUND: A comprehensive and context-specific approach to monitoring financial protection can provide valuable evidence on progress towards universal health coverage. OBJECTIVES: This article systematically reviews the literature on financial protection in Europe to identify trends across countries and over time. It also maps the availability of data for regular monitoring in 53 countries. METHODS: Two people independently searched for studies using a standard strategy. Results were extracted from 54 publications and studies analysed in terms of geographical focus, data sources, methods and depth of analysis. RESULTS: Financial protection varies across countries in Europe; substantial changes over time have mainly taken place in the east of the region. Although the data required for regular monitoring are widely available, the literature presents major gaps in geographical scope - most studies focus on middle-income countries; it is not up to date - the latest year of data analysed is 2011; and cross-national comparison is only possible for a handful of countries due to variation in data sources and methods. The literature is also limited in depth. Very few studies go beyond analysing how many people incur catastrophic or impoverishing out-of-pocket payments. Only a small minority analyse who is most likely to experience financial hardship and what drives lack of financial protection. CONCLUSIONS: The literature provides little actionable evidence on financial protection in Europe.