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Revisiting out-of-pocket requirements : Trends in spending, financial access barriers, and policy in ten high-income countries

Rice, Thomas ; Quentin, Wilm ; Anell, Anders LU ; Barnes, Andrew J. ; Rosenau, Pauline ; Unruh, Lynn Y. and Van Ginneken, Ewout (2018) In BMC Health Services Research 18(1).
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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Access, Coinsurance, Comparative health systems, Copayments, Cost-sharing, Deductibles, Out-of-pocket costs
in
BMC Health Services Research
volume
18
issue
1
article number
371
publisher
BioMed Central
external identifiers
  • scopus:85047198487
  • pmid:29776404
ISSN
1472-6963
DOI
10.1186/s12913-018-3185-8
language
English
LU publication?
yes
id
4ef40eeb-1b5d-4b63-a3d5-fa475a55b301
date added to LUP
2018-06-01 13:30:04
date last changed
2020-02-19 04:59:32
@article{4ef40eeb-1b5d-4b63-a3d5-fa475a55b301,
  abstract     = {<p>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.</p>},
  author       = {Rice, Thomas and Quentin, Wilm and Anell, Anders and Barnes, Andrew J. and Rosenau, Pauline and Unruh, Lynn Y. and Van Ginneken, Ewout},
  issn         = {1472-6963},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Health Services Research},
  title        = {Revisiting out-of-pocket requirements : Trends in spending, financial access barriers, and policy in ten high-income countries},
  url          = {http://dx.doi.org/10.1186/s12913-018-3185-8},
  doi          = {10.1186/s12913-018-3185-8},
  volume       = {18},
  year         = {2018},
}