Forgone care and financial burden due to out-of-pocket payments within the German health care system

Bremer, Patrick

doi:10.1186/s13561-014-0036-0

Cited by 36 publications

(37 citation statements)

References 23 publications

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“…The resulting pattern of what constitutes the most vulnerable groups remains remarkably robust. SUN is a more serious issue for the children of the poor (the reader is referred to a systematic review of the literature on children until 2006 [22] and some later studies [23][24][25][26][27][28][29]), for the homeless [30][31][32][33], for chronically ill patients [19,20,[34][35][36], for the disabled [21,37,38], for the sick and poor elderly [39][40][41][42] and for immigrants [43]. Extending insurance coverage for these groups or strengthening social protection measures (lowering OOP payments or increasing their income) should be an obvious target for any policy aiming at improving equity of access.…”

Section: Subjective Unmet Need and Out-of-pocket Paymentsmentioning

confidence: 99%

“…Many surveys have introduced subjective indicators of postponing or forgoing needed healthcare and have related it to different causes [2,[13][14][15]39]. One of the main factors contributing to this postponement is the amount patients pay out of pocket (OOP) at their point of access to the system: doctors' fees, cost of medicines or glasses, hospital bills [13].…”

Section: Introductionmentioning

confidence: 99%

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Out-of-Pocket Payments and Subjective Unmet Need of Healthcare

Schokkaert

Steel

Voorde

2017

Appl Health Econ Health Policy

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We present a critical review of the literature that discusses the link between the level of out-of-pocket payments in developed countries and the share of people in these countries reporting that they postpone or forgo healthcare for financial reasons. We discuss the pros and cons of measuring access problems with this subjective variable. Whereas the quantitative findings in terms of numbers of people postponing care must be interpreted with utmost caution, the picture for the vulnerable groups in society is reasonably robust and unsurprising: people with low incomes and high morbidity and incomplete (or non-existent) insurance coverage are most likely to postpone or forgo healthcare for financial reasons. It is more surprising that people with high incomes and generous insurance coverage also report that they postpone care. We focus on some policy-relevant issues that call for further research: the subtle interactions between financial and non-financial factors, the possibility of differentiation of out-of-pocket payments between patients and between healthcare services, and the normative debate around accessibility and affordability.

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Section: Subjective Unmet Need and Out-of-pocket Paymentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Out-of-Pocket Payments and Subjective Unmet Need of Healthcare

Schokkaert

Steel

Voorde

2017

Appl Health Econ Health Policy

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“…[20,21]. Es wurde gefragt, ob in den vergangenen zwölf Monaten auf eine Versorgungsleistung verzichtet wurde, weil diese etwas kostete oder nicht zur Verfügung stand bzw.…”

Section: Hintergrundunclassified

“…Tab. 1; [21]). Der Verzicht auf einen Arztbesuch aus Kostengründen war in einer anderen Untersuchung nicht mit Einkommen und Bildung, allerdings positiv mit dem GKVStatus assoziiert [22].…”

Section: Hintergrundunclassified

Soziale Unterschiede in der ambulanten und stationären Versorgung

Klein

Knesebeck

2015

Bundesgesundheitsbl.

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There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.

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“…Equity in health financing is not only related to the amount of THE, but also the structure among the three components [4]. Increasing the proportion of OOP may cause people to forgo care and become poor [5][6][7]. In 2010, OOP pushed an estimated 97 million people (1.4% of the world' s population) below the US$ 1.90 per day extreme poverty line [8].…”

mentioning

confidence: 99%