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Patient cost-sharing arrangements in the 27 European Union

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Patient cost-sharing arrangements in the 27 European Union Powered By Docstoc
					Patient payments
in Europe
  Wim Groot
  Maastricht University
  Sustainable Financing of Health Care systems
  March 24-25, 2011, Bucharest
                                                                              ASSPRO CEE 2007
                                                                              Collaborative Focused Research Project
                                                                              FP7-SSH-2007 Grant Agreement No.: 217431




                                    Assessment of patient payment policies and
                              projection of their efficiency, equity and quality effects:

                                      The case of Central and Eastern Europe




                                               ASSPRO CEE 2007
                                           http://assprocee2007.com
Project funded under
the Socio-economic Sciences
and Humanities theme




European Commission
                              Consortium                                             ASSPRO CEE 2007
                                                                                     Collaborative Focused Research Project
                                                                                     FP7-SSH-2007 Grant Agreement No.: 217431




                              Number            Beneficiary name             Short                  Country
                                                                             name

                                1      Universiteit Maastricht                                The
                                                                           UM
                                       (coordinator)                                          Netherlands

                                2      Medical University of Varna         MU-Varna           Bulgaria

                                3      Public Enterprise “MTVC”            MTVC               Lithuania

                                       Scoala Nationala de Sanatate
                                4                                          SNSPMS             Romania
                                       Publica si Management Sanitar

                                5      Shkola Ohorony Zdorovia             SOZ                Ukraine

                                       Uniwersytet Jagiellonski
                                6                                          UJ CM              Poland
Project funded under
the Socio-economic Sciences
and Humanities theme                   Collegium Medicum
                                       Center for Public Affairs Studies
                                7                                          CPASF              Hungary
                                       Foundation


European Commission
Research Team
• Project coordinator:
   Milena Pavlova


• Scientific coordinators:
   Wim Groot, Frits van Merode


• Researchers:
   Jelena Arsenijevic, Elka Atanasova, Petra Baji,
   Andriy Danyliv, Vladimir Gordeev,
   Tetiana Stepurko, Marzena Tamor, Sonila Tomini
BEOZ
For further reference:
• M. Tambor, M. Pavlova, P. Woch & W. Groot (2010).
  Diversity and dynamics of patient cost-sharing
  for physicians’ and hospital services in the 27
  European Union countries.
  European Journal of Public Health. Forthcoming.
  http://eurpub.oxfordjournals.org/content/early/2010/09/29/eurpub.ckq139.abstract


• T. Stepurko, M. Pavlova, I. Gryga & W.Groot
  (2010).
  Empirical studies on informal patient payments
  for health care services: A systematic and
  critical review of research methods and
  instruments.
  BMC Health Services Research 10:273


BEOZ
Patient payments

• Formal cost-sharing arrangements

• Informal payments




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Formal-informal patient payment mix in Europe

                                                          2                         3                     5
                                                          Belgium, Cyprus,          Austria, Croatia,     Albania, Bulgaria,
       Formal obligatory/unavoidable service fees



                                                          Finland, Germany,         Czech Republic,
                                                                                                          Latvia, Lithuania
                                                          Iceland, Ireland,         Estonia, France,
                                                    yes




                                                          Netherlands,              Italy,
                                                                                    Luxembourg
                                                          Norway, Portugal,
                                                          Slovenia, Sweden,



                                                          1                                               6
                                                                                      4                   Greece, Hungary,
                                                          Denmark, Malta,
                                                          Spain, UK                                       Poland, Romania,
                                                                                                          Russia, Slovakia,
                                                    no




                                                                                                          Turkey, Ukraine,




                                                             no                       s ome cases           wi dely s pread

                                                                              Informal patient payments


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Formal and informal payment
systems differ by

• Recipient

• Purpose of payment

• Amount of payment

• Exemptions and structure of payment

BEOZ
Source:
Stepurko et al.: Empirical studies
on informal patient payments for
health care services: a systematic
and critical review of research
methods and instruments.
BMC Health Services Research
2010, 10:273.



BEOZ
• Formal cost-sharing arrangements and
  informal payments seem independent from
  eachother

• Formal cost-sharing does not seem an
  option to eradicate informal payments




BEOZ
Formal cost-sharing policies

• To improve efficiency and quality of
  health care

• To contain (public) health care expenditures

• To generate revenues for health care

• To improve sustainability of health care
  system
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Types of cost-sharing

  Cost-sharing = official arrangement aimed to
  partially involve the user in the payment for
  public health care services

  Four types of cost-sharing
   – Co-payments
   – Co-insurance
   – Deductibles
   – Reference pricing (extra billing)
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Basic
characteristics
of the EU
health care
systems
(2007-2008)




Source:
Tambor, M., Pavlova, M., Woch, P. & Groot,
W. (2010). Diversity and dynamics of patient
cost-sharing for physicians’ and hospital
services in the 27 European Union countries.
European Journal of Public Health.
Forthcoming.

BEOZ
                        Co-payments as percentage of total health care expenditures, 2000-2004
                                       2000         2001        2002         2003        2004
                        Canada         15.9         15.2        15.2         14.5         14.9
                        Denmark        16.0         15.9        15.8         13.9         13.9
                        Germany        10.6         10.7        10.3         10.4


                        France         10.5         10.4         7.9          7.7         7.6
                        Greece         44.9         42.4        43.3         43.7         45.2
                        Italy          22.8         20.3        20.4         20.7         19.6
                        Japan          16.9         16.5        17.3         17.3


                        Luxemburg       7.0         6.5          6.9          6.7         6.7
                        Netherlands     9.0         8.7          8.0          7.9         7.8
                        Norway         16.7         15.7        15.8         15.5         15.7
                        Austria        16.7         15.7        15.0         15.0         14.7
                        Poland         30.0         28.1        25.4         26.4         28.1
                        Portugal       22.2         23.2        22.3         21.2         21.6
                        Spain          23.6         23.9        23.7         24.1         23.6

Source:                 Tsjech rep.     9.5         10.1         9.7         10.0         10.4
OECD Health Data 2006   United         14.9         14.2        13.7         13.5         13.2
                        States
BEOZ
                        Switzerland    32.9         31.7        31.5         31.6         31.9
Characteristics health care systems
27 EU countries
• Insurance based systems prevail over tax
  based systems
• Three methods of paying for GP’s:
  capitation, salary and fee-for-service
• Medical specialists: fee-for-service and salary
• GP gate keeping is rather common
• Only in 7 member states patients do not
  need a referral from a GP


BEOZ
Patient cost-
sharing
arrangements in
the EU for three
types of services
(2007-2008)




Source:
Tambor, M., Pavlova, M., Woch, P. & Groot,
W. (2010). Diversity and dynamics of patient
cost-sharing for physicians’ and hospital
services in the 27 European Union countries.
European Journal of Public Health.
Forthcoming.

BEOZ
Characteristics cost-sharing
arrangements
• In nearly half the member states there are
  no formal patient cost-sharing arrangements
  for GP, medical specialists or hospital care
• The most common type of cost-sharing for
  GP is co-payment followed by coinsurance
  and mixed patient cost-sharing
• The same forms of cost-sharing are applied
  to medical specialists and hospital care
• Cost-sharing for pharmaceuticals in EU is
  more diverse
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Exemption mechanisms

• The majority of EU countries has exemptions
  in case of low income, age (children,
  pensioners) or poor medical status

• Only 2 countries have no exemptions




BEOZ
  Patient cost-sharing arrangements in the EU
  have been changing considerably (mostly
  being extended) during the last decades and
  they are quite diverse at present.




BEOZ
The
dynamics
of patient
cost-
sharing in
the EU


Source:
Tambor, M., Pavlova, M.,
Woch, P. & Groot, W. (2010).
Diversity and dynamics of
patient cost-sharing for
physicians’ and hospital
services in the 27 European
Union countries. European
Journal of Public Health.
Forthcoming.

BEOZ
Relation cost-sharing and financial
characteristics health care systems
• GP gate keeping does not preclude the
  application of cost-sharing for physician
  services and vice versa: without gate-
  keeping not always cost-sharing for medical
  specialists

• Coinsurance is most common in case of fee-
  for-service to providers, co-payment goes
  together with salaries and capitation
  payment
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Relation cost-sharing and financial
characteristics health care systems
• Absence of cost-sharing is most frequent in
  countries where GP’s are paid capitation and
  medical specialists are paid fee-for-service
• Cost-sharing is slightly more common in
  countries with insurance systems
• In tax based systems co-payments are most
  frequent for physician and hospital services
• In insurance based systems cost-sharing
  arrangements are more pluralistic
• For pharmaceuticals cost-sharing
  arrangements are diverse in both systems
BEOZ
Relation cost-sharing and financial
characteristics health care systems



 No significant relation between exemptions
 and financial characteristics of health care
 systems in EU countries




BEOZ
Conclusion


• Formal and informal patient payments are
  largely independent from each other

• Heterogeneity in patient payment systems
  within EU

• No sign of convergence in patient payments


BEOZ
    Thank you
for your attention
   Wim Groot
   Professor of Health Economics

				
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