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Health care consumers’ opinions on different variants of out-of-pocket payments. A cross-sectional questionnaire study (2013).

Reitsma, M., Jong, J. de. Health care consumers’ opinions on different variants of out-of-pocket payments. A cross-sectional questionnaire study (2013). European Journal of Public Health: 2014, 24(suppl. 2) . Abstract: 7th European Public Health Conference 'Mind the Gap: Reducing Inequalities in health and health care'. 19-22 November 2014, Glasgow.
Background: Health care expenditures are rising faster than the resources in many countries. One of the tools to reduce this expenditures is by introducing out-of-pocket payments. With these payments insured have to pay (part of) the costs of health care themselves. One of the aims of out-of pocket payments is that it leads to less health care use. The assumption is that out-of-pocket-payments lead to a higher cost consciousness which is assumed to lead to cost conscious behavior and herewith to less health care use. In the Netherlands, in 2008 the obliged deductible has been introduced, a type of out-of-pocket payment. Since the behavioral effect of the obliged deductible is limited and since there are indications that the obliged deductible affects some
groups of people more than other groups, it’s worth to examine other variants of out-of-pocket-payments. The objective of this study is to examine the supposed behavioural effect on healthcare use of four different variants of out-of-pocket payments from a consumer perspective. Methods: In November 2013, a questionnaire was sent to 1500 members of the Dutch Health Care Consumer Panel. The response was 47%. For four different variants of out of pocket payments it was asked to what extent people expect cost consciousness, cost consciousness behavior and to less health care use. The four different variants are: an obliged deductible, a shifted obliged deductible, an income dependent deductible and a charge per service. Results: For all four different variants of out-of-pocket payments, respondents expect that it will lead to cost consciousness, cost consciousness behavior and less health care use. The supposed effect of the obliged deductible is the strongest. There are differences between groups, e.g. older people more often think that out-of-pockets payments leads to cost consciousness. Conclusions: Support seems high for all variants. The supposed behavioral effect is the highest for the obliged deductible. This might be
due to the fact that health care users are used to this variant. Other results, however, show that in practice people are not cost conscious and that effects of out-of-pocket measures have the downside of postponing necessary health care use. From our study this could be the case for all variants.
Key messages
The expected behavioral effect of four different forms of out-of-pocket-payments is high.
There are differences between groups in the behavioral effect they expect.
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