FAQ

The financial burden of out-of-pocket patient payments in the European Union and accession countries: 
Results of a systematic literature review

Publication date: 2015

Public Health and Governance, 2014, Volume 12, Issue 3, pp. 239 - 247

https://doi.org/10.4467/20842627OZ.14.025.3443

Authors

,
Konstantin Moser
Faculty of Health, Medicine and Life Sciences, Maastricht University
All publications →
,
Milena Pavlova
Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands / Top Institute Evidence-Based Education Research (TIER), Maastricht University, The Netherlands
https://orcid.org/0000-0002-6082-8446 Orcid
All publications →
Wim Groot
Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands / Top Institute Evidence-Based Education Research (TIER), Maastricht University, The Netherlands
https://orcid.org/0000-0003-1035-5916 Orcid
All publications →

Titles

The financial burden of out-of-pocket patient payments in the European Union and accession countries: 
Results of a systematic literature review

Abstract

A major issue for public health policy is to reduce the poverty and catastrophic effects of out-of-pocket payments. This paper reviews empirical studies that analyze the financial burden of out-of-pocket payments and factors that are associated with this burden for households in the EU and accession countries. The method of systematic literature review is applied. Poverty effects appear to be independent of geographical area. Catastrophic healthcare expenditure ranges from a bit less than 0.05% to nearly 4%, and the impoverishment due to out-of-pocket payments is also up to 4%. Analyses carried out in single countries reveal that living in a household with a pensioner contributes most to high payments for health care. The results support calls for health policy to prevent the burden of out-of-pocket payments, especially for pharmaceutical expenditure. Special attention should be paid to risk groups such as pensioners, female headed households and low income households.

References

Thomson S., Foubister T., Mossialos E., Financing health care in the European Union: challenges and policy responsesEuropean Observatory on Health Systems and Policies, London 2009.

OECD, Health at Glance: Europe 2012, OECD Publishing 2012.

Mladovsky P., Srivastava D., Cylus J., Karanikolos M., Evetovits T., Thomson S., McKee M., Health policy responses to the financial crisis in Europe, WHO Regional Office for Europe, Copenhagen 2012.

Pavlova M., Tambor M., van Merode G.G., Groot W., Are patient charges an effective policy tool? Review of theoretical and empirical evidence, “Public Health and Management” 2010; VIII(1): 29–36.

Ferrer-i-Carbonell A., van Praag B.M.S., The subjective costs of health losses due to chronic diseases: an alternative model for monetary appraisal, “Health Economics” 2002; 11(8): 709–722.

Tambor M., Pavlova M., Golinowska S., Sowada C., Rechel B., Groot W., The formal-informal patient payment mix in European countries: governance, economics, culture or all of these?, “Health Policy” 2013; 113(3): 284–295.

Wagstaff A., Measuring financial protection in health. The World Bank Development Research Group, Washington 2008.

Arsenijevic J., Pavlova M., Groot W., Measuring the catastrophic and impoverishing effect of household health care spending in Serbia, “Social Science & Medicine” 2013; 78: 17–25.

van Damme W., van Leemput L., Por I., Hardeman W., Meessen B., Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia, “Tropical Medicine & International Health” 2004; 9(2): 273–280.

Xu H., James C., Carrin G., Muchiri S., An empirical model of access to health care, health care expenditure and impoverishment in Kenya: learning from past reforms and lessons for the future, World Health Organization, Geneva 2005.

Wagstaff A., van Doorslaer E., Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998, “Health Economics” 2003; 12(11): 921–934.

Tambor M., Pavlova M., Woch P., Groot W., Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries“European Journal of Public Health” 2012; 21(5): 585–590.

Flores G., Krishnakumar J., O’Donnell O., van Doorslaer E., Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty, “Health Economics” 2008; 17(12): 1393–1412.

Atanasova E., Pavlova M., Moutafova E., Rechel B., Groot W., Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access“European Journal of Public Health” 2013; 23(6): 916–922.

Bredenkamp C., Mendola M., Gragnolati M. Catastrophic and impoverishing effects of health expenditure: new evidence from the Western Balkans“Health Policy and Planning 2011; 26(4): 349–356.

Dukhan Y., Korachais C., Xu K., Saksena P., Mathonnat, J., Financial burden of health payments in France: 1995–2006, World Health Organization, Geneva 2010.

Habicht J., Xu K., Couffinhal A., Kutzin J., Detecting changes in financial protection: creating evidence for policy in Estonia, “Health Policy and Planning” 2006; 21(6): 421–431.

Krutilova V., Yaya S., Unexpected impact of changes in out-of-pocket payments for healthcare on Czech household budgets, “Health Policy” 2012; 107(2–3): 276–288.

Luczak J., Garcia-Gomez P., Financial burden of drug expenditures in Poland, “Health Policy” 2012; 105(2–3): 256–264.

Vork A., Habicht J., Xu K., Kutzin J., Income related inequality in health care financing and utilization in Estonia since 2000, WHO Regional Office for Europe, Copenhagen 2010.

Xu K., Evans D., Kawabata K., Zeramdini R., Klavus J., Murray C., Household catastrophic health expenditure: multicountry analysis“The Lancet” 2003; 362: 111–117.

Xu K., Saksena P., Jowett G., Kutzin J., Rurane A., Access to health care and the financial burden of out-of-pocket health payments in Latvia, World Health Organization, Geneva 2009.

Xu K., Evans D.B., Carrin G., Aguilar-Rivera A.M., Musgrove P., Evans T., Protecting households from catastrophic health spending, “Health Affairs” 2007; 26(4): 972–983.

Yardim M.S., Cilingiroglu N., Yardim N., Financial protection in health in Turkey: the effects of the Health Transformation Programme, “Health Policy and Planing” 2014; 29(2): 177–192.

Tambor M., Pavlova M., Golinowska S., Sowada C., Rechel B., Groot W., The inability to pay for health services in Central and Eastern Europe: evidence from six countries“European Journal of Public Health” 2014; 24(3): 378–385.

Heijink R., Xu K., Saksena P., Evans D., Validity and comparability of out-of-pocket health expenditure from household surveys: review of the literature and current survey instrumentsWorld Health Organization, Geneva 2010.

Kawabata K., Xu K., Carrin, G., Preventing impoverishment through protection against catastrophic health expenditure, “Bulletin of the World Health Organization” 2002; 80(8): 612.

Information

Information: Public Health and Governance, 2014, Volume 12, Issue 3, pp. 239 - 247

Article type: Original article

Titles:

Polish:
The financial burden of out-of-pocket patient payments in the European Union and accession countries: 
Results of a systematic literature review
English:
The financial burden of out-of-pocket patient payments in the European Union and accession countries: 
Results of a systematic literature review

Authors

Faculty of Health, Medicine and Life Sciences, Maastricht University

https://orcid.org/0000-0002-6082-8446

Milena Pavlova
Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands / Top Institute Evidence-Based Education Research (TIER), Maastricht University, The Netherlands
https://orcid.org/0000-0002-6082-8446 Orcid
All publications →

Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands / Top Institute Evidence-Based Education Research (TIER), Maastricht University, The Netherlands

https://orcid.org/0000-0003-1035-5916

Wim Groot
Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands / Top Institute Evidence-Based Education Research (TIER), Maastricht University, The Netherlands
https://orcid.org/0000-0003-1035-5916 Orcid
All publications →

Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands / Top Institute Evidence-Based Education Research (TIER), Maastricht University, The Netherlands

Published at: 2015

Article status: Open

Licence: None

Percentage share of authors:

Konstantin Moser (Author) - 33%
Milena Pavlova (Author) - 33%
Wim Groot (Author) - 34%

Article corrections:

-

Publication languages:

English