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

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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.

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Authors and Affiliations

  1. Department of Economics, KU Leuven and CORE, Université catholique de Louvain, Louvain-la-Neuve, Belgium

    Erik Schokkaert

  2. Department of Economics, KU Leuven, Louvain, Belgium

    Jonas Steel & Carine Van de Voorde

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  1. Erik Schokkaert
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  2. Jonas Steel
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  3. Carine Van de Voorde
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The authors contributed equally to the content of the paper. The final version was written by ES.

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Correspondence to Erik Schokkaert.

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Erik Schokkaert, Jonas Steel and Carine Van de Voorde have no conflicts of interest.

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No external funding was received for the work reported in this study.

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Schokkaert, E., Steel, J. & Van de Voorde, C. Out-of-Pocket Payments and Subjective Unmet Need of Healthcare. Appl Health Econ Health Policy 15, 545–555 (2017). https://doi.org/10.1007/s40258-017-0331-0

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