Limitations in the scope of benefits

12 Inequities in access to health care for vulnerable groups in Europe and Central Asia.docx , 5 + 3 1 A + 4 B . The impact of catastrophic health expenditure on increases in poverty indicators is shown in figure 10. While such expenditures increased the poverty indicators in Kyrgyzstan by 2.4 per cent and by 3.2 per cent in Kazakhstan, in Romania an impact of 7.6 per cent was observed. In Armenia and Belarus, the impact was measured at 8.4 per cent, and reached 8.8 per cent in the Republic of Moldova. It was in Bulgaria that catastrophic health expenditure had the highest impact on poverty levels, at 31.9 per cent. . + 4 B . The number of households affected by financial catastrophe and related inequities in access to health services is significant throughout the European region, as indicated in figure 11: 6 per cent of all households in the Russian Federation, 7.2 per cent in 64.4 9.4 32.5 61 15.8 40.3 4.8 19 41.2 67.7 10.1 35.4 62.4 16.3 43.9 6.3 20.6 44.6 Tajikistan Romania Moldova Kyrgyzstan, Rep. Of Kazakhstan Georgia Bulgaria Belarus Armenia Poverty indicator after catastrophic exenditure Poverty indicator before catastrophic exenditure 5.1 7.6 8.8 2.4 3.2 9 31.9 8.4 8.4 Tajikistan Romania Moldova Kyrgyzstan, Rep. Of Kazakhstan Georgia Bulgaria Belarus Armenia Impoverishing effect, impact Inequities in access to health care for vulnerable groups in Europe and Central Asia.docx 13 Azerbaijan, and 7.6 per cent of households in Croatia suffer from health-related catastrophic expenditures. 8 2 , + Out-of-pocket expenditures may not only result in catastrophic expenditures and lead to impoverishment, but may also act as a barrier to accessing care in the first place. In the Republic of Moldova, for example, 40.1 per cent of households reported difficulties in accessing health care due to financial reasons, and 15.3 per cent of households were unable to access health services at all due to financial barriers prior to the introduction of mandatory social health insurance in 2004. Although this reform significantly facilitated access for the insured, an estimated 24.3 per cent of the population remain uninsured. The most vulnerable population groups – including the rural self-employed, the unemployed and particularly unemployed women – remain excluded from social health insurance and thus lack protection against out-of-pocket expenditures Atun et al., 2008. The fact that inequities in access are strongly linked to the income status of those in need is illustrated by data on access to maternal health care in low- and middle-income countries, which include many CEE and CIS countries. These inequities are shown by wealth quintile in figure 12: while between 78 and 95 per cent of women in the highest wealth quintile in these countries had access to maternal health services, this was true for only 23 to 55 per cent in the lowest quintile of the same country group.