Forgone care and financial burden due to out-of-pocket payments within the German health care system
Tóm tắt
The amount of out-of-pocket (OOP) payments within the German health care system has risen steadily within the last years. OOP payments aim to strengthen patients’ cost awareness and try to restrict the demand on medical necessary treatments. However, besides the intended decline of non-induced health care services there’s a risk that people also forgo necessary treatments because the utilization of health care services depends not only on need-factors but also on the ability to pay for it. Therefore, this paper aims to analyze the determinants of the total amount of OOP payments, the financial burden caused by OOP payments and the relinquishment of health care services due to OOP payments. The empirical analysis is based on cross-sectional data of the German subsample (n = 2851) of the Survey of Health, Ageing and Retirement in Europe (SHARE). SHARE is a representative panel study among private households with persons above the age of 50 years and covers a wide range of topics, e.g. health behavior, health status and information about the socio-economic status. The analysis of the independent variables “total amount of OOP payments”, “financial burden due to OOP payments” and “forgone care” is carried out by the means of descriptive as well as multivariate regression methods. Individuals with low income as well as people suffering from chronic illnesses face a higher financial burden and forgo health care services more frequently at the same time. E.g. the financial burden of people who belong to the lowest income quintile is about eight times higher compared to individuals who belong to the highest quintile. The probability of forgone care for this group is about 5.6 percentage points higher [95% CI: 5.2 – 6.0]. Especially for the group of people with chronic illnesses and low-income earners it cannot be ruled out that they also forgo necessary medical treatments due to the relatively high financial burden they face. Hence, it is required to facilitate the access to necessary care for these groups.
Tài liệu tham khảo
Statistisches Bundesamt [https://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/dboowasys921.xwdevkit/xwd_init?gbe.isgbetol/xs_start_neu/&p_aid=3&p_aid=5624967&nummer=322&p_sprache=D&p_indsp=99999999&p_aid=82916889]
Beske F, Golbach U: Zuzahlungen im Gesundheitswesen: Grundlagen, internationaler Vergleich und Konzepte für die Gesetzliche Krankenversicherung. Schriftenreihe des Fritz Beske Instituts für Gesundheits-System-Forschung, Kiel; 2009.
Pfaff AB, Langer B, Mamberer F, Freund F, Kern OA, Pfaff M: Zuzahlungen nach dem GKV-Modernisierungsgesetz (GMG) unter Berücksichtigung von Härtefallregelungen. INEFS-Universität Augsburg, Volkswirtschaftliche Diskussionsreihe, Augsburg; 2003.
Gruber J: The Role of Consumer Copayments for Health Care: Lessons from the RAND Health Insurance Experiment and Beyond. Kaiser Family Foundation Report, Washington, DC; 2006.
Schulenburg JM: Selbstbeteiligungen: Theoretische und empirische Konzepte für die Analyse ihrer Allokations- und Verteilungswirkungen. Tübingen: Schriften zur angewandten Wirtschaftsforschung 1987, 51.
Wagstaff A, Van Doorslaer E: Equity in the finance and delivery of health care: Some international comparisons. J of Health Economics 1992, 11: 361–387. 10.1016/0167-6296(92)90012-P
Baji P, Pavlova M, Gulácsi L, Groot, W: Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary. Int J Equity Health 2012: 11–36.
Akazili J, Gyapong J, McIntyre D: Who pays for health in care in Ghana? Int J Equity Health 2011: 10–26.
Sambamoorthi U, Shea D, Crystal S: Total and out-of-pocket expenditures for prescription drugs among older persons. Gerontologist 2003, 43: 345–359. 10.1093/geront/43.3.345
Klein D, Turvey C, Wallace R: Elders who delay medication because of cost: health insurance, Demographic, health and financial correlates. Gerontologist 2004, 44: 779–787. 10.1093/geront/44.6.779
Crystal S, Johnson RW, Harman J, Sambamoorthi U, Kumar R: Out-of-pocket health care costs among older Americans. J Gerontol B Psychol Sci Soc Sci 2000, 55: 51–62. 10.1093/geronb/55.1.S51
Rogowski J, Lillard LA, Kongton R: The financial burden of prescription drug use among older persons. Gerontologist 1997, 37: 475–482. 10.1093/geront/37.4.475
Wei WH, Akincigil A, Crystal S, Sambamoorthi U: Gender differences in out-of-pocket prescription drug expenditures among the elderly. Research on Aging 2006, 28: 427–453. 10.1177/0164027505284046
Holst J: Kostenbeteiligungen für Patienten – Reformansatz ohne Evidenz! Theoretische Betrachtungen und empirische Befunde aus Industrieländern. Berlin: Wissenschaftszentrum Berlin für Sozialforschung (WZB) Discussion Paper; 2008.
Litwin H, Sapir E: Forgone health care due to cost among older adults in European countries and in Israel. European J of Ageing 2009, 6: 167–176. 10.1007/s10433-009-0126-8
Piette JD, Heisler M, Wagner TH: Cost-Related Medication Underuse Among Chronically Ill Adults: the Treatments People Forgo, How often, and Who is at Risk. Am J of Public Health 2004, 94: 1782–1787. 10.2105/AJPH.94.10.1782
Holst J, Laaser U: Zuzahlungen im Gesundheitswesen: Unsozial, diskriminierend und ineffektiv. Deutsches Ärzteblatt 2003, 51(100):3358–3361.
Sozialgesetzbuch Fünftes Buch, Gesetzliche Krankenversicherung (SGB V) § 62, Belastungsgrenze, 2014.
Bremer P, Sauerland D, Wübker A: Zuzahlungen im deutschen Gesundheitssystem: Ausmaß, Determinanten und Konsequenzen für die Medikamenteninanspruchnahme. In Gesundheitsmonitor 2013. Edited by: Böcken J, Braun B, Repschläger U. Verlag Bertelsmann Stiftung, Gütersloh; 2013:169–187.
Schreyögg J, Grabka MM: Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Eur J Health Econ 2010, 11: 331–341. 10.1007/s10198-009-0179-9
Winkelmann R: Co-payments for prescription drugs and the demand for doctor visits – Evidence from a natural experiment. Health Econ 2004, 13: 1081–1089. 10.1002/hec.868
Mielck A, Kiess R, von dem Knesebeck O, Stirbu I, Kunst AE: Association between forgone care and household income among the elderly in five Western European countries – analyses based on survey data from the SHARE-study. BMC Health Serv Res 2009, 9: 52. 10.1186/1472-6963-9-52
Böhm K: Tesch-Römer C. Ziese, T: Gesundheit und Krankheit im Alter. Beiträge zur Gesundheitsberichterstattung des Bundes. Berlin; 2009.
Brugiavini A, Croda E, Paccagnella O, Rainato R, Weber G: Generated Income Variables in SHARE release 1, In The Survey of Health Ageing and Retirement in Europe: Methodology. Börsch-Supan A, Jürges H et al. (eds). Mannheim Research Institute for the Economics of Ageing, Mannheim; 2005, 105–113.
Grossman M: On the concept of health capital and the demand for health. J Polit Econ 1972, 80: 223–255. 10.1086/259880
Van Doorslaer E, Masseria C: Income-Related Inequality in the Use of Medical Care in 21 OECD Countries. Paris: OECD Working Paper No. 14; 2004.
Jones A: Applied Econometrics for Health Economists: A Practical Guide. London: Radcliffe Medical Press; 2007.
O’ Donnell O, van Doorslaer E, Wagstaff A, Lindelow M: Analyzing Health Equity Using Household Survey Data. A Guide to Techniques and Their Implementation. The World Bank Institute, Washington, D.C; 2008.
Corrieri S, Heider D, Matschinger H, Lehnert T, Raum E, König HH: Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients – a systematic review. Int J Equity Health 2010: 9–20.
Tamblyn R, Laprise R, Hanley J, Abrahamowicz M, Scott S, Mayo NE, Hurley J, Grad R, Latimer E, Perrault R, McLeod P, Huang AS, Larochelle P, Mallet L: Adverse Events Associated with Prescription Drug Cost-Sharing Among Poor and Elderly Persons. JAMA 2001, 285: 421–429. 10.1001/jama.285.4.421
Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S: Payment Restrictions for Prescription Drugs under Medicaid. N Engl J Med 1987, 27: 550–556. 10.1056/NEJM198708273170906
Richardson J: The Effects of Consumer Co-payments in Medical Care. Melbourne: National Health Strategy Background Paper No. 5; 1991.