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One last effort. Are high out-of-pocket payments at the end of life a fatality?

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Abstract

Only few studies outside of the US have addressed the issue of out-of-pocket payments (OOP) at the end of life because of a lack of data. We use an exclusive dataset from a major French health insurance company (MGEN), including claim data, both mandatory and voluntary health insurance details, income and individual characteristics, for individuals aged 65 or older who died in 2017. We address three main issues: (1) What is the magnitude of OOP in France at the end of life? (2) How are OOP distributed, and do they present a financial risk to patients? (3) What are the determinants of OOP and what health system reforms could reduce them? Our results indicate that OOP expenses increase in the last year of life and accelerate in the last trimester. Despite some outliers, the French system is successful in protecting individuals from catastrophic OOP. Using generalised linear models, we confirm that improving the pathways of care could generate savings and partially reduce households’ financial burden. However, OOP are elastic to income and driven essentially by personal convenience demands. Using concentration curves and Gini coefficients, we show that providing additional insurance against end-of-life OOP would likely be regressive, i.e., socially non-desirable.

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Fig. 1

Source: Éracles, year 2017

Fig. 2

Source: Éracles, year 2017

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Notes

  1. For instance, according to Kelley et al. [13], health expenses and OOP vary according to the cause of death, indicating a financial risk of inequality in the face of death. They find that for Medicare enrolees, the average OOP is highest for dementia (81% more than other patients) and lowest for patients who died of heart disease or cancer.

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Acknowledgements

We thank Carine Franc from the French National Institute for Health and Medical Research (INSERM), the participants of the 41st JESF and 68th AFSE annual meetings and two anonymous reviewers for their useful comments.

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Authors and Affiliations

  1. MGEN Foundation for Public Health, 3 sq Max Hymans, 75015, Paris, France

    Rosalind Bell-Aldeghi, Morgane Le Guern & Christine Sevilla-Dedieu

  2. Universite de Paris, LIRAES, Chair of Innovation and Value in Health, 75006, Paris, France

    Rosalind Bell-Aldeghi

  3. Arènes (UMR CNRS 6051), École des Hautes Études en Santé Publique, Rennes, France

    Nicolas Sirven

  4. IRDES, Institut de Recherche et Documentation en Économie de la Santé, Paris, France

    Nicolas Sirven

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  1. Rosalind Bell-Aldeghi
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Correspondence to Rosalind Bell-Aldeghi.

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Bell-Aldeghi, R., Sirven, N., Le Guern, M. et al. One last effort. Are high out-of-pocket payments at the end of life a fatality?. Eur J Health Econ 23, 879–891 (2022). https://doi.org/10.1007/s10198-021-01401-1

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