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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.

Abstract:In comparison to other European countries, it is claimed that the Czech Republic belongs to the countries with higher health care consumption, even if health status does not positively correlate with health care use. Therefore, user fees as a form of patient cost sharing were introduced to regulate health care consumption and to confront the patient with resource scarcity in the health care system as a part of health care reform package in 2008. The goal of the paper is to determine the changes in health care consumption after user fees implementation and evaluate their regulatory effect in a short period of time. The analysis of the changes in health care consumption is made on the basis of data from the largest health insurance company -VZP ČR (60 % of the Czech population). The health care consumption is monitored according to particular types of health care services for particular age groups in years 2007, 2008 and 2009. This analysis identifies the major changes in the consumption after user fees implementation among the observed age groups of Czech population. Furthermore, it is possible to prove the regulatory effect of user fees in a short period of time (2 years).

The system of cost sharing has changed several times in the Czech Republic, and it is not out of the question that further changes will take place. High out-of-pocket payments have a considerable impact on patients and the burden on their household budgets. Therefore, we aim to evaluate the impact of out-of-pocket payments on the burden of Czech households from a long term perspective and to determine the most vulnerable groups, taking into account policy changes across the observed period of 2007-2014. We use micro data from the Household Budget Survey conducted by the Czech Statistical Office. The burden and its changes are observed and a burden breakdown for out-of-pocket payment types is made. Special attention is paid to households with members aged 65 or more, and also to households with children. To estimate the burden, regression models are run using the Ordinary Least Square method with robust standard errors. We found that the burden is not equitably distributed among households, but that it tends to decrease with time. Modifications in user fees contributed to this decreasing trend. Even though protective mechanisms from high out-of-pocket payments are applied in the health care system, households with members aged over 65 years faced the highest burden. Another significant predictor of the high burden is household income and the presence of a health problem. Improvement of protection would be justifiable, especially in relation to the income situation of the household.