OBJECTIVES: Increasing patients’ copayment rates was one of the cost-containment strategies during the economic crisis’ years. The main objective of this study was to explore whether out-of-pocket pharmaceutical payments (OOPP) increased catastrophic expenditures for health in Greece.

METHODS: Data for 51,842 households and their 125,641 members were derived from the Greek Household Budget Surveys during the period 2008-2018. The impact of OOPP on poverty is defined as the difference between the estimates of poverty measures before and after pharmaceutical payments, by using the methods proposed by the World Health Organization. Poverty estimates are expressed in 2018 constant prices, while the poverty line is also anchored in 2008.

RESULTS: Between 2008 and 2018, mean annual equivalized total consumption decreased by 31.5% (from €17,991 to €12,318), and total out-of-pocket health spending by 20.5% (from €996.6 to €792.5), while OOPP increased by 37.6%, (from €203.3 to €279.8). The percentage of the population at-risk-of-poverty before OOPP increased from 14.5% in 2008 to 38.4% in 2018 (i.e., 164.5% relative increase), while the respective estimates after OOPP were 15.1% and 40.1%, respectively (i.e., 165.8% relative increase). As a result, while 0.6% of the population was impoverished due to OOPP in 2008, the respective estimate for 2018 was calculated at 1.7% (i.e., 197.9% relative increase). The middle and lower-middle income classes also incurred the largest OOPP with increases of 23,7%, 37,5% and 74,3% for the 2nd, 3rd and 4th quintiles.

CONCLUSIONS: As a result of cost-shifting strategies, out of pocket pharmaceutical spending by households in Greece increased during the crisis, whereas total and overall health consumption were reduced in the same period. The number of households bearing catastrophic expenditures tripled between 2008-2018 (from 8% in 2008 to 24% in 2018), leading to impoverishment of the households and increased inequality.