Monitoring financial protection to assess progress towards universal health coverage in Europe

European countries led the way in moving towards universal health coverage in the 20th century. The economic crisis and other factors have challenged this achievement in some countries, highlighting the need for vigilance to sustain progress. Assessments of universal health coverage commonly measure health system performance in two areas: (i) the extent to which people are prevented from using services because of access barriers (unmet need for health care); and (ii) the extent to which people are shielded from financial hardship when they use health services (financial protection). The European Union regularly monitors unmet need, but Europe lacks a comprehensive set of estimates for financial protection, even though the necessary data are routinely available in most countries. To address this gap, the World Health Organization Regional Office for Europe has initiated a project to produce up-to-date estimates of financial protection using a new approach better suited to high- and middleincome countries in the region. We explain why financial protection matters, briefly review conventional ways of measuring it, show how the World Health Organization European Region’s adapted metrics add value and describe how context-specific monitoring can generate actionable evidence for policy-making.