Abstract
Decision makers are used to consider Out-of-Pocket Expenditure (OOPE) within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system. In this paper, we provide estimates on the determinants of OOPE in Italy by using data coming from an observational cross-sectional study that enrolled a sample of 2526 patients suffering from inflammatory bowel diseases. We explore the association between OOPE and: (1) geographical location; (2) income effects; (3) performances in delivering healthcare. A regression model was used. Individuals’ age were in the range of 18–88 (mean 44 ± 14.55). Forty-six percent were females, 54% were married and 19% held a bachelor degree. Ninety-six percent of respondents declared an OOPE >0 whose mean value was €960 ± €950. Individuals belonging to low-income and low-performance regions were more likely to declare an OOPE >0 (99%). Regression findings suggest that increases in OOPE could be considered as a response from patients aiming to compensate for lacks and inefficiencies in the public healthcare offers. Policymakers should consider increases in OOPE in patients with Inflammatory Bowel Diseases (IBDs) as an indicator of poor quality of care and poor fairness.
Highlights
Out-of-pocket expenditures (OOPE) refer to that portion of services, medicines, examinations, and therapies that are not covered by public health systems
Decision makers are used to consider OOPE within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system
Since food for nutritional support is not reimbursed by the Italian public health system, we considered it as a potential significant predictor for the OOPE estimate
Summary
Out-of-pocket expenditures (OOPE) refer to that portion of services, medicines, examinations, and therapies that are not covered by public health systems. Issues related to OOPE have been analyzed with a particular focus on low- and middle-income countries [2], as fees for public and private healthcare impose relevant economic constraints on patients [3,4,5]. For this reason, OOPE has been defined as “the most unequal and inefficient way to fund health care” [5,6]. Due to public healthcare budget constraints, more complex needs of the population, ageing and the growing expenditure for medical technologies, OOPE has grown with a yearly rate ranging between 3 and 5% in the vast majority of the developed countries in the last decade [1]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call