The Out-of-pocket Burden of Chronic Diseases: the Cases of Belgian, Czech and German Older Adults

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2021 Mar 18

PMID 33731090

Citations 9

Authors

Veronika Kocis Krutilova

Lewe Bahnsen

Diana De Graeve

Affiliations

Soon will be listed here.

Abstract

Background: Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium, the Czech Republic and Germany.

Methods: Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe is used. A two-part model with a logit model in the first part and a generalised linear model in the second part is applied.

Results: The diseases increasing the burden in the observed countries are heart attacks, high blood pressure, cancer, emotional disorders, rheumatoid arthritis and osteoarthritis. Reflecting country differences Parkinson's disease and its drug burden is relevant in Belgium, the drugs burden related to heart attack and outpatient care burden to chronic kidney disease in the Czech Republic and the outpatient care burden of cancer and chronic lung disease in Germany. In addition, we confirm the regressive character of out-of-pocket payments.

Conclusions: We conclude that the burden is not equitably distributed among older adults with chronic diseases. Identification of chronic diseases with a high burden can serve as a supplementary protective feature.

Citing Articles

Catastrophic Health Expenditure among Iranian Households: Evidence from the COVID-19 Era.

Sheikhy-Chaman M, Rezapour A, Aryankhesal A, Aboutorabi A Med J Islam Repub Iran. 2024; 38:49.

PMID: 39399604 PMC: 11469731. DOI: 10.47176/mjiri.38.49.

Journey Through Healthcare of People With Complications of Type 2 Diabetes: A Qualitative Study of Lived Experiences.

De Baets S, Danhieux K, Dirinck E, Lapauw B, Wouters E, Remmen R Int J Integr Care. 2024; 24(2):18.

PMID: 38798720 PMC: 11122697. DOI: 10.5334/ijic.7604.

Influence of comorbidity of chronic diseases on basic activities of daily living among older adults in China: a propensity score-matched study.

Zeng H, Miao C, Wang R, Zhao W, Wang W, Liu Y Front Public Health. 2024; 12:1292289.

PMID: 38638478 PMC: 11024351. DOI: 10.3389/fpubh.2024.1292289.

Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

Carpio-Arias T, Crovetto-Mattassi M, Duran-Aguero S, Parra-Soto S, Landaeta-Diaz L, Cerezo de Rios S J Prim Care Community Health. 2023; 14:21501319231204580.

PMID: 37902498 PMC: 10617253. DOI: 10.1177/21501319231204580.

A scoping review on the factors associated with the lost to follow-up (LTFU) amongst patients with chronic disease in ambulatory care of high-income countries (HIC).

Tong C, Koh R, Lee E BMC Health Serv Res. 2023; 23(1):883.

PMID: 37608296 PMC: 10464417. DOI: 10.1186/s12913-023-09863-0.

References

Schokkaert E, Van Ourti T, De Graeve D, Lecluyse A, Van de Voorde C . Supplemental health insurance and equality of access in Belgium. Health Econ. 2009; 19(4):377-95. DOI: 10.1002/hec.1478. View

Mihaylova B, Briggs A, OHagan A, Thompson S . Review of statistical methods for analysing healthcare resources and costs. Health Econ. 2010; 20(8):897-916. PMC: 3470917. DOI: 10.1002/hec.1653. View

Alexa J, Recka L, Votapkova J, van Ginneken E, Spranger A, Wittenbecher F . Czech Republic: health system review. Health Syst Transit. 2015; 17(1):1-165. View

Abegunde D, Stanciole A . The economic impact of chronic diseases: how do households respond to shocks? Evidence from Russia. Soc Sci Med. 2008; 66(11):2296-307. DOI: 10.1016/j.socscimed.2008.01.041. View

Baird K . The incidence of high medical expenses by health status in seven developed countries. Health Policy. 2015; 120(1):26-34. DOI: 10.1016/j.healthpol.2015.10.004. View

Islam M, Yen L, Valderas J, McRae I . Out-of-pocket expenditure by Australian seniors with chronic disease: the effect of specific diseases and morbidity clusters. BMC Public Health. 2014; 14:1008. PMC: 4182884. DOI: 10.1186/1471-2458-14-1008. View

Jeon Y, Essue B, Jan S, Wells R, Whitworth J . Economic hardship associated with managing chronic illness: a qualitative inquiry. BMC Health Serv Res. 2009; 9:182. PMC: 2766369. DOI: 10.1186/1472-6963-9-182. View

Palladino R, Lee J, Hone T, Filippidis F, Millett C . The Great Recession And Increased Cost Sharing In European Health Systems. Health Aff (Millwood). 2016; 35(7):1204-13. DOI: 10.1377/hlthaff.2015.1170. View

Bock J, Matschinger H, Brenner H, Wild B, Haefeli W, Quinzler R . Inequalities in out-of-pocket payments for health care services among elderly Germans--results of a population-based cross-sectional study. Int J Equity Health. 2014; 13:3. PMC: 3893415. DOI: 10.1186/1475-9276-13-3. View

10.

Busse R, Blumel M . Germany: Health system review. Health Syst Transit. 2014; 16(2):1-296, xxi. View

11.

Mullahy J . Much ado about two: reconsidering retransformation and the two-part model in health econometrics. J Health Econ. 1998; 17(3):247-81. DOI: 10.1016/s0167-6296(98)00030-7. View

12.

Cantoni E, Ronchetti E . A robust approach for skewed and heavy-tailed outcomes in the analysis of health care expenditures. J Health Econ. 2006; 25(2):198-213. DOI: 10.1016/j.jhealeco.2005.04.010. View

13.

Buntin M, Zaslavsky A . Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ. 2004; 23(3):525-42. DOI: 10.1016/j.jhealeco.2003.10.005. View

14.

Biro A . Copayments, gatekeeping, and the utilization of outpatient public and private care at age 50 and above in Europe. Health Policy. 2013; 111(1):24-33. DOI: 10.1016/j.healthpol.2013.03.009. View

15.

Narci H, Sahin I, Yildirim H . Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey. Eur J Health Econ. 2014; 16(3):255-70. DOI: 10.1007/s10198-014-0570-z. View

16.

Baird K . High Out-of-Pocket Medical Spending among the Poor and Elderly in Nine Developed Countries. Health Serv Res. 2016; 51(4):1467-88. PMC: 4946036. DOI: 10.1111/1475-6773.12444. View

17.

Andersen R, NEWMAN J . Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973; 51(1):95-124. View

18.

Arsenijevic J, Pavlova M, Rechel B, Groot W . Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries. PLoS One. 2016; 11(7):e0157765. PMC: 4933384. DOI: 10.1371/journal.pone.0157765. View

19.

Bremer P . Forgone care and financial burden due to out-of-pocket payments within the German health care system. Health Econ Rev. 2015; 4(1):36. PMC: 4502068. DOI: 10.1186/s13561-014-0036-0. View

20.

Bernell S, Howard S . Use Your Words Carefully: What Is a Chronic Disease?. Front Public Health. 2016; 4:159. PMC: 4969287. DOI: 10.3389/fpubh.2016.00159. View