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

Rice, Thomas; Quentin, Wilm; Anell, Anders; Barnes, Andrew J.; Rosenau, Pauline Vaillancourt; Unruh, Lynn; Ginneken, Ewout van

doi:10.1186/s12913-018-3185-8

Cited by 66 publications

(70 citation statements)

References 11 publications

(11 reference statements)

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“…OOPCs can vary greatly by country, with countries with low public funding of healthcare costs (e.g. the United States) reporting higher OOPCs and more frequent reports of barriers to health service access (Rice et al, ). Furthermore, the costs of resources are highly variable across countries.…”

Section: Discussionmentioning

confidence: 99%

The direct and indirect financial costs of informal cancer care: A scoping review

Coumoundouros

Brahim

Lambert

et al. 2019

Health Soc Care Community

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Informal caregivers are the primary source of support for cancer patients, providing assistance with household tasks, medical care and emotional support. These responsibilities often result in high levels of emotional, physical, social and financial burden for the caregiver. The aim of this study was to perform a scoping review exploring what is known regarding the financial costs experienced by caregivers and identify gaps in the literature. Seven databases were searched for articles published between May 2008 and May 2018 related to direct and indirect costs of informal cancer care. Included articles reported on the costs incurred by cancer caregivers as a dollar value, relied on caregiver‐reported costs and were peer reviewed. A total of 19 studies met the inclusion criteria. These studies reported out of pocket costs‚ opportunity costs of informal care time and caregiver time loss from paid employment. Care time was the largest source of cancer caregiver costs, averaging $4,809 per month when valued using the proxy good method or $2,877 per month when the opportunity cost approach was used. Caregiver costs were highest when the care recipient was in the palliative phase of the disease. There was an absence of literature reporting costs for cancer caregivers in low and middle income countries and none of the included studies considered costs related to the caregivers' medical expenditures. There were many challenges when comparing the costs across studies due to variations in the type of expenses reported and the methods used to value expenses. Quantifying the financial costs associated with being an informal caregiver can facilitate the communication of the financial burden caregivers experience, potentially spurring the development of policies and programs to reduce their financial burden and better support cancer caregivers.

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Section: Discussionmentioning

confidence: 99%

The direct and indirect financial costs of informal cancer care: A scoping review

Coumoundouros

Brahim

Lambert

et al. 2019

Health Soc Care Community

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“…Current data from the World Bank show that 7% of the population in 110 countries spend up to 10% of their total consumption as OOPE for healthcare services. Those OOPEs stand in direct relation to healthcare access and hence represent an important barrier to healthcare use . Evidence indicates that even in case of partial user fee removal, the very poor and ill often cannot afford to pay for their treatment due to uncovered costs or have to sell assets in order to be able to do so .…”

Section: Introductionmentioning

confidence: 99%

“…As policies are implemented to reform health financing and service provision, the international community explicitly recognizes the need to monitor OOPE as an essential parameter against which to evaluate the progress being made toward Universal Health Coverage (UHC) . Several authors have argued in favor of measuring OOPE and its determinants even prior to the implementation of new UHC policies, as a means of generating baseline values against which to assess improvements in financial protection …”

Section: Introductionmentioning

confidence: 99%

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Nakovics

Brenner

Robyn

et al. 2019

Health Planning & Management

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Summary Introduction Overwhelming evidence suggests that out‐of‐pocket expenditures (OOPEs) hamper access to care and impose a heavy economic burden across sub‐Saharan Africa (SSA). Still, current user fee reduction and removal policies often target specific groups and services, leaving large sections of the population exposed to OOPE. Methods To estimate the magnitude and the determinants of OOPE for curative services in Burkina Faso, we used data from a household survey conducted in 24 districts between October 2013 and March 2014 (n = 7844). Given a context of medical pluralism, we purposely focused on total OOPE irrespective of type of care sought. We used a two‐part regression model to estimate determinants of OOPE. Results Nearly 60% of those who reported an illness episode incurred a positive expenditure, with an average amount of 9362.52 FRS CFA per episode (1 USD = 577.94 FRS CFA). The first model revealed that the probability of incurring a positive OOPE was positively associated with perceived illness severity (P < .001), hospitalization (P < .001), and negatively associated with age (P = .026), distance (P = .060), and poorest wealth quintile (P = .054). The second model revealed that the magnitude of OOPE was positively associated with age (P = .087), education (P = .025), being household head (P = .015), having a chronic comorbidity (P = .025), perceived illness severity (P = .029), and hospitalization (P < .001) and negatively associated with symptoms unlikely to lead to adverse outcomes if not attended to in time (P = .056). Conclusion Our findings indicate that OOPEs remain a problem in Burkina Faso and that broader spectrum policy reforms are urgently needed to ensure adequate financial protection.

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“…This suggests overall lower cost-sharing requirements for hospital care than ambulatory care across health-care settings. [68][69][70] Our results also showed that nonmedical costs at destination and home country contributed considerably to the direct costs of dengue illness in travelers, averaging US$152 and US$171 per patient for hospitalization, and US$61 and US$79 per patient for ambulatory care, respectively.…”

Section: Discussionmentioning

confidence: 59%

“…Small sample size precluded an analysis and comparison of out-of-pocket medical spending for dengue illness by home country to account for the differences in the health-care systems, which affect cost-sharing requirements for a given basket of health services across countries. 68 Although most hospitalized patients reported having health insurance coverage for medical expenditures, they failed to reliably report on the received or anticipated reimbursement amount. This may be related to the factors associated with reimbursement processes depending on the type of health insurance, particularly for medical expenditures incurred abroad, including complex reimbursement requirements, lengthy processing wait times, and payment delays, all of which may even affect how many claims are successfully filed and accepted.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers

Tozan

Headley

Sewe

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient's perspective and paves the way for future economic burden studies in this population.

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

Cited by 66 publications

References 11 publications

The direct and indirect financial costs of informal cancer care: A scoping review

The direct and indirect financial costs of informal cancer care: A scoping review

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers

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