This comprehensive review examines the challenges and opportunities in achieving financial protection within the Moldovan healthcare system. It highlights the system’s progress and persistent gaps using data from the National Bureau of Statistics (2008–2016). The document, titled “Can people afford to pay for health care? New evidence on financial protection in the Republic of Moldova”, became available at WHO website on December 9, 2020
Key Findings:
Catastrophic Spending:
- Prevalence: In 2016, 17% of households experienced catastrophic health spending, an increase from 14% in 2008.
- Impact on Poverty: Nearly 7% of households were impoverished or further impoverished due to out-of-pocket health expenses.
- Concentration Among Vulnerable Groups: Catastrophic spending is predominantly concentrated among the poorest households, rural residents, and pensioners.
Drivers of Financial Hardship:
- Outpatient Medicines: Spending on outpatient medicines is the main driver of catastrophic health spending, especially among poorer households.
- Dental Care: Financial hardship from dental care primarily affects the wealthiest households, reflecting unmet needs among poorer groups.
- Co-payment Policies: Heavy reliance on percentage co-payments, lack of overall caps, and insufficient exemptions for the poor exacerbate financial vulnerability.
Unmet Needs and Inefficiencies:
- Dental Care: Limited dental care coverage exposes poorer households to unmet needs and financial hardship.
- Medicines: Inefficiencies in procurement, pricing, prescribing, and dispensing of outpatient medicines contribute to financial protection challenges.
- Comparative Perspective:
- The incidence of catastrophic health spending in Moldova is higher than in most WHO European Region countries due to persistent coverage gaps:
- Entitlement Based on Contributions: Restricts access for 12% of the eligible population, exacerbating inequality and inefficiency.
- Limited Public Spending: Despite economic growth, public health investment has not kept pace, undermining financial protection efforts.
- WHO advises the following to improve financial protection in Moldova:
- Expand Coverage and Reduce Costs:
- Extend the range of essential outpatient medicines covered by the National Health Insurance Company (CNAM).
- Introduce co-payment exemptions for poor households and regular healthcare users, including older people.
- Revise Co-payment Policies:
- Reduce reliance on percentage co-payments to minimize exposure to fluctuating prices.
- Implement caps on co-payments to protect vulnerable populations.
- Enhance Efficiency:
- Address inefficiencies in the procurement, pricing, prescribing, and dispensing of medicines.
- Reform Entitlement Basis:
- Transition entitlement to CNAM benefits from contributions-based to residence-based to ensure universal access.
- Increase Public Investment:
- Ensure that public health spending grows in line with or exceeds economic growth to support coverage expansion and financial protection.
Achievements and Challenges:
Government initiatives, including the establishment of CNAM and the gradual expansion of benefits, have improved healthcare access and reduced unmet needs. However, persistent gaps in coverage and financial hardship from out-of-pocket payments continue to undermine financial protection, especially for the poorest and most vulnerable populations. Addressing these gaps will require sustained policy reform and increased public investment.
