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Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema

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  • Gregoire Mercier
  • Jenica Pastor
  • Valerie Clément
  • Ulysse Rodts
  • Christine Moffat
  • Isabelle Quéré

Abstract

Out-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. We measured the lymphedema-specific outpatient out-of-pocket payments over 6 months. The vertical equity of out-of-pocket payments was examined using concentration curves, the Gini coefficient for income, the Kakwani index, and the Reynolds-Smolensky index. We included 231 lymphedema patients aged 7 years or more, living in metropolitan France, and being able to use Internet and email. After voluntary health insurance reimbursement, the mean out-of-pocket payment was equal to 101.4 Euros per month, mainly due to transport (32%) and medical devices (26%). Concentration curves indicated regressivity of out-of-pocket payments. Total out-of-pocket payments represented 10.1% of the income by consumption unit for the poorest quintile and 3.5% for the wealthiest (p

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  • Gregoire Mercier & Jenica Pastor & Valerie Clément & Ulysse Rodts & Christine Moffat & Isabelle Quéré, 2019. "Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-13, May.
    • Handle: RePEc:plo:pone00:0216386
    DOI: 10.1371/journal.pone.0216386
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