Good intentions and the costs of inaction: Financial protection in Austria.

Understanding the financial strain of health care costs borne by households is crucial for assessing the equity and affordability of a health system. Building on an already generous system, Austrian health policy has strived over decades to include more and more people in its Social Health Insurance Schemes and to find ways to lower individual financial burden. Using data from the Austrian household budget survey for the years 2004/05, 2009/10, 2014/15 and 2019/20, this study investigates whether these efforts have been successful. Analyzing expenditures on various health care types, including medicines, medical products, outpatient care, dental care, diagnostic tests and inpatient care, our study aims to determine how the percentage of households experiencing catastrophic health expenditure (CHE) according to WHO definitions has changed over time. Logistic regression analyses were carried out to identify factors associated with CHE. The results reveal an increase in the prevalence of CHE from 2.1 % in 2004/05 to 3.6 % in 2019/20. Across all survey rounds, at least 60% of households experiencing CHE belonged to the poorest consumption quintile. Age, sex, educational attainment and employment status of the head of the household emerged as factors associated with CHE from the regression analysis. The observed rise in CHE is surprising given Austria's generous health system and the introduction of policies during the study period aimed at expanding the breadth and depth of coverage. It serves as an example for other countries that failing to tackle underlying structural problems in the healthcare system may counteract financial protection policies.