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(Adverse) effects of out-of-pocket-payments in health care.

Reitsma-van Rooijen, M. (Adverse) effects of out-of-pocket-payments in health care. European Journal of Public Health: 2012, 22(suppl. 2), p. 263. Abstract. 5th European Public Health Conference 'All inclusive public health'. 7-10 November 2012, St. Julians (Malta).
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Background: Health care expenditures are rising in many countries. This might be caused by the fact that there is no direct relation between health care use and costs, since, for example, these costs have been paid by the insurance. If patients do not fully face the costs, this might lead to excessive use of health care and thereby contribute to growing expenditures. To reduce this excessive and possible improper use of health care, and herewith to reduce health care expenditures, different out-ofpocket-payments for health care use have been introduced. Out-of-pocket-payments mainly aim at a funding shift and more efficient use of health care by health care consumers. The objective of this study is to gain insight into changes in health care use by consumers due to these payments. We focused on two effects: efficiency and equity. We examined whether only inappropriate, or also appropriate health care use is affected and whether it lead to possible inequalities in health status between groups. In our study we focused on two different types of out-of-pocket-payments on consumers: deductibles and co-payment for inappropriate use of the Emergency Ward. Methods: The effects of deductibles and co-payment for the Emergency Ward were measured among members of the Dutch Health Care Consumer Panel in two different surveys. Data were available for deductibles for 1,059 respondents (response rate 68%) and for co-payment for Emergency Ward for 1,114 respondents (response rate 75%). Results: Only a small percentage respondents state that they use less health care due to the deductibles. They also state that they do not use health care inappropriately. The higher the out-of-pocket-payments, the more barriers consumers experience to make use of health care. Results indicate that out-of-pocket-payments also reduce appropriate health care use. Preliminary results show that they appear to create inequalities between groups. Conclusions: The effects of out-of-pocket-payments depend on the height of the out-of-pocket payments. The higher the out-of-pocket-payment the more it reduces health care use. The effect on efficiency seems to be small. Negative side effect is the reduction of appropriate use. Furthermore, out-of-pocket-payments seem to create inequalities between groups. (aut. ref.)
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