Out-of-Pocket Payments and Subjective Unmet Need of Healthcare

Abstract

We present a critical review of the literature that discusses the link between the level of out-of-pocket payments in developed countries and the share of people in these countries reporting that they postpone or forgo healthcare for financial reasons. We discuss the pros and cons of measuring access problems with this subjective variable. Whereas the quantitative findings in terms of numbers of people postponing care must be interpreted with utmost caution, the picture for the vulnerable groups in society is reasonably robust and unsurprising: people with low incomes and high morbidity and incomplete (or non-existent) insurance coverage are most likely to postpone or forgo healthcare for financial reasons. It is more surprising that people with high incomes and generous insurance coverage also report that they postpone care. We focus on some policy-relevant issues that call for further research: the subtle interactions between financial and non-financial factors, the possibility of differentiation of out-of-pocket payments between patients and between healthcare services, and the normative debate around accessibility and affordability.

Incentivizing efficient utilization without reducing access: The case against cost‐sharing in insurance

“…Schoen et al (2010) survey access impediments in eleven countries. For a recent review of the literature on the relationship between out-of-pocket cost and utilization, see Schokkaert, Steel, and Van de Voorde (2017). 6 Boone (2018) provides a nice analysis which conditions should be covered by basic or supplementary insurance if patients face access problems.…”

No unmet needs without needs! Assessing the role of social capital using data from European social survey 2014

“…Evaluating access to healthcare through the analysis of self-reported unmet needs has some limitations, related with reporting behaviour, preferences, and it also leaves out individuals who do not report unmet needs but who spend a large share of their budgets on healthcare, even to such an extent that it must consume less of other necessary commodities [51]. It is also possible that some of the perceived needs are indeed needs for social rather than healthcare [14,52].…”

Putting measures of individual well-being to use for ex-ante policy evaluation

“…Raising the income of a person will not immediately improve his/her health. Moreover, unmet needs of medical treatment are not only caused by lack of income; therefore, it is a very strong assumption that they would be fully covered after an income transfer (see, e.g., Schokkaert et al 2017). Yet, the presence of these positive effects in the longer run is extensively documented in the literature, and neglecting them would certainly lead to an underestimation of the well-being gains for the concerned groups.…”