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Main Title: Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries
Author(s): Rice, Thomas
Quentin, Wilm
Anell, Anders
Barnes, Andrew J.
Rosenau, Pauline
Unruh, Lynn Y.
van Ginneken, Ewout
Type: Article
Language Code: en
Abstract: Background Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. The article examines trends in OOP spending in ten high-income countries since 2000, and analyzes their relationship to self-assessed barriers to accessing health care services. The countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Methods Data from three sources are employed: OECD statistics, the Commonwealth Fund survey of individuals in each of ten countries, and country-specific documents on health care policies. Based on trends in OOP spending, we divide the ten countries into three groups and analyze both trends and access barriers accordingly. As part of this effort, we propose a conceptual model for understanding the key components of OOP spending. Results There is a great deal of variation in aggregate OOP spending per capita spending but there has been convergence over time, with the lowest-spending countries continuing to show growth and the highest spending countries showing stability. Both the level of aggregate OOP spending and changes in spending affect perceived access barriers, although there is not a perfect correspondence between the two. Conclusions There is a need for better understanding the root causes of OOP spending. This will require data collection that is broken down into OOP resulting from cost sharing and OOP resulting from direct payments (due to underinsurance and lacking benefits). Moreover, data should be disaggregated by consumer groups (e.g. income-level or health status). Only then can we better link the data to specific policies and suggest effective solutions to policy makers.
Issue Date: 18-May-2018
Date Available: 29-Nov-2018
DDC Class: 610 Medizin und Gesundheit
Subject(s): access,
deduc tibles
comparative health systems
out-of-pocket costs
Sponsor/Funder: TU Berlin, Open-Access-Publikationsfonds – 2018
Journal Title: BMC Health Services Research
Publisher: BioMed Central
Publisher Place: London
Volume: 18
Issue: 1
Article Number: 371
Publisher DOI: 10.1186/s12913-018-3185-8
ISSN: 1472-6963
Appears in Collections:FG Management im Gesundheitswesen » Publications

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