The out-of-pocket burden of chronic diseases: the cases of Belgian, Czech and German older adults

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.

Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions

“…Female-headed households are more likely to face a burden of high OOP expenditures than their male-headed counterparts [ 31 ], due to having different demographic, sociological, and economic characteristics both in developed and developing countries [ 32 ]. Poor health status, disability, and severe or complicated illnesses or conditions often result in higher OOP health expenditures [ 33 , 34 , 35 ]. For instance, a study conducted in Germany, Belgium, and Czechia found that specific chronic diseases increase the overall OOP burden with a strong association for the medicine burden [ 33 ].…”

“…Poor health status, disability, and severe or complicated illnesses or conditions often result in higher OOP health expenditures [ 33 , 34 , 35 ]. For instance, a study conducted in Germany, Belgium, and Czechia found that specific chronic diseases increase the overall OOP burden with a strong association for the medicine burden [ 33 ]. Another study performed in Australia concluded that OOP health expenditures are common among senior Australians with chronic conditions, and this expenditure increases with the number of chronic conditions [ 34 ].…”

Older adults and family caregivers’ experience of digital health technology in frailty care: A systematic review and meta-ethnography protocol

“…The inability to perform ADLs and IADLs implies further pressure on government expenditure, as long-term care assistance may be required 8 . In addition to government spending, out-of-pocket payments for individuals with chronic health conditions are higher due to increased health-care use, lower earnings due to disability, early retirement, and dependence on social security systems 9 – 11 .…”

Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis

“…Over recent decades, several governments have sought to improve the health of the population while reducing the associated financial burden. However, the presence of universal healthcare access and extensive coverage does not completely eliminate the requirement for out-of-pocket (OOP) payments to receive healthcare goods and services [ 3 ]. OOP health expenditure refers to all payments spent on medical costs such as consultation fees, medicine, diagnosis, laboratory, radiology, and admission, along with other non-medical expenses such as transportation [ 4 , 5 ].…”

“…Additionally, the chronically ill have less generous health insurance coverage than the non-chronically ill as treatments for chronic conditions are usually of high cost [ 8 ]. These factors constrain household budgets, leading to a significant increase in the financial burden for households and individuals with chronic illness [ 3 ].…”