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

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.

[1]  N. Yardim,et al.  Financial protection in health in Turkey: the effects of the Health Transformation Programme. , 2014, Health Policy and Planning.

[2]  B. Rechel,et al.  The inability to pay for health services in Central and Eastern Europe: evidence from six countries , 2013, European journal of public health.

[3]  W. Groot,et al.  The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these? , 2013, Health policy.

[4]  B. Rechel,et al.  Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access. , 2013, European journal of public health.

[5]  W. Groot,et al.  Measuring the catastrophic and impoverishing effect of household health care spending in Serbia. , 2013, Social science & medicine.

[6]  S. Yaya,et al.  Unexpected impact of changes in out-of-pocket payments for health care on Czech household budgets. , 2012, Health policy.

[7]  Martin McKee,et al.  Health policy responses to the financial crisis in Europe , 2012 .

[8]  Pilar García-Gómez,et al.  Financial burden of drug expenditures in Poland. , 2012, Health policy.

[9]  W. Groot,et al.  Diversity and dynamics of patient cost-sharing for physicians' and hospital services in the 27 European Union countries. , 2011, European journal of public health.

[10]  M. Gragnolati,et al.  Catastrophic and impoverishing effects of health expenditure: new evidence from the Western Balkans. , 2011, Health policy and planning.

[11]  P. Saksena.  Validity and Comparability of Out-of- pocket Health Expenditure from Household Surveys: A review of the literature and current survey instruments , 2011 .

[12]  G. G. Merode,et al.  Are patient charges an effective policy tool? Review of theoretical and empirical evidence , 2010 .

[13]  Elias Mossialos,et al.  Financing health care in the European Union: challenges and policy responses , 2009 .

[14]  E. van Doorslaer,et al.  Coping with Health-Care Costs: Implications for the Measurement of Catastrophic Expenditures and Poverty , 2008, Health economics.

[15]  A. Wagstaff.  Performance measurement for health system improvement: Measuring financial protection in health , 2010 .

[16]  D. Evans,et al.  Protecting households from catastrophic health spending. , 2007, Health affairs.

[17]  Ke Xu,et al.  Detecting changes in financial protection: creating evidence for policy in Estonia. , 2006, Health policy and planning.

[18]  G. Carrin,et al.  An empirical model of access to health care, health care expenditure and impoverishment in Kenya: learning from past reforms and lessons for the future , 2006 .

[19]  B. Meessen,et al.  Out‐of‐pocket health expenditure and debt in poor households: evidence from Cambodia , 2004, Tropical medicine & international health : TM & IH.

[20]  Adam Wagstaff,et al.  Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. , 2003, Health economics.

[21]  C. Murray,et al.  Household catastrophic health expenditure: a multicountry analysis , 2003, The Lancet.

[22]  A. Ferrer-i-Carbonell,et al.  The Subjective Costs of Health Losses Due to Chronic Diseases: An Alternative Model for Monetary Appraisal , 2001, Health economics.

[23]  G. Carrin,et al.  Preventing impoverishment through protection against catastrophic health expenditure. , 2002, Bulletin of the World Health Organization.