Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients
- a systematic review
Sandro Corrieri 1,2 , Dirk Heider 1 , Herbert Matschinger 3 , Thomas Lehnert 2 , Elke Raum 4 and Hans-Helmut König 1,2
1
2 Department of Medical Sociology and Health Economics,
3
4 Division of Clinical Epidemiology and Aging Research,
International Journal for Equity in Health – August 2010, 9:20doi:10.1186/1475-9276-9-20
Available online at: http://bit.ly/aumRwS
“…..In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs [1]. Major concerns in this topic revolve around inequalities in burden for subgroups of society, being unproportionally charged for health care services because of their socioeconomic background. The difference in financial strain is displayed in a larger share of income that must be invested in health care services, leading to dissimilar efforts for comparable benefits, and disadvantages for low-income beneficiaries.
There are three major forms of copayments. Firstly, there is a varying amount that must be paid by the patient before the insurance company steps in, called deductible. Regularly, a higher deductible is associated with a lower premium, leaving the beneficiary with a lower basic amount, but at higher risk in case of morbidity. Secondly, the co-insurance marks the amount of out-of-pocket payments OOPP the beneficiary has to spend after the deductible limit is reached.
The insurer only pays a stipulated percentage share of the costs, while the patient pays for the rest. Thirdly, and in the focus of this article, there are direct out-of-pocket payments OOPP for health-care services. Examples are costs for prescription medications, hospital stays, alternative medicine, physiotherapy or home nursing, which are not covered by insurance policies and have to be paid by the patients themselves [2].
All three forms of copayments are suspected to evoke or reinforce inequalities in burdens for beneficiaries, especially regarding predispositions in education, sex and, foremost, income, as will be explored in this review.
In the
The present review gives an overview of the inequalities of out-of-pocket payments OOPP by the fastest growing population, the elderly aged 65+, associated with income, education and sex. In the elderly, inequalities are likely to be most apparent due to extensive use of medical services caused by age-related morbidity. Purpose of this task is to provide a basis, serving as foundation for future studies focusing on the mechanisms causing the described inequalities….”
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