Abstract
BackgroundCountries 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.MethodsData 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.ResultsThere 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.ConclusionsThere 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.
Highlights
Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques
The second group consists of countries in which OOP spending is in the middle range (Sweden, Australia, Germany, Canada); they have experienced a decreasing rate of growth when comparing the period 1994–2004 with 2004–2014, but OOP payments are still increasing
The fact that in some countries there was little to no increase in constant US$purchasing power parities (PPP) does not mean that there was no increase in spending when expressed in the local currency or that no extra cost-sharing requirements were implemented
Summary
Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. All countries rely on out-of-pocket (OOP) spending to help fund their health care systems. OOP spending includes both direct payments made for uncovered services (due to lack of insurance or lacking benefits) and cost sharing requirements such as coinsurance and deductibles. It serves two main purposes: as a source of revenue, and to help reduce demand for services. Controversy surrounds OOP payments and opponents typically voice two concerns. Charging people for their medical care means that those with the greatest need, and those with the lowest. The purpose of this article is to: (a) systematically assess trends in OOP spending in ten prominent highincome countries as well as trends in people’s perception of any resulting impediments regarding accessing needed
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