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Patient cost sharing and social inequalities in access to health care in three western European countries

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  • Lostao, Lourdes
  • Regidor, Enrique
  • Geyer, Siegfried
  • Aïach, Pierre

Abstract

This study evaluates the association between social class and health services use in France, Germany and Spain, three countries with universal health coverage but with different cost-sharing systems. In France, patients share the cost of both physician visits and hospitalization, in Germany they share the cost of hospitalization, and in Spain there is no system of patient cost sharing. The data were obtained from national health surveys carried out in each of these countries during the last decade of the 20th century. We found that persons belonging to a low social class had fewer physician visits than those belonging to a high social class in France, whereas the opposite occurred in Germany and Spain. After adjusting for a measure of the need for health care, the results in France changed little, whereas no significant differences by social class were seen in Germany and Spain. Persons of low social class had more hospital admissions than those of high social class in France and Spain, while no statistically different differences were seen in Germany. After adjusting for need, no significant differences were seen in any of the three countries. Although other factors related with the structure of the health system can not be ruled out, our findings suggest that patient cost sharing reduces the frequency of physician visits and that this decrease is greater in the low social classes, whereas the effect of co-payment for hospitalization on the frequency of hospital admission is not clear.

Suggested Citation

  • Lostao, Lourdes & Regidor, Enrique & Geyer, Siegfried & Aïach, Pierre, 2007. "Patient cost sharing and social inequalities in access to health care in three western European countries," Social Science & Medicine, Elsevier, vol. 65(2), pages 367-376, July.
  • Handle: RePEc:eee:socmed:v:65:y:2007:i:2:p:367-376
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    References listed on IDEAS

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    8. repec:aph:ajpbhl:1987:77:7:801-804_0 is not listed on IDEAS
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    Cited by:

    1. Martín-Fernández, Jesús & Gómez-Gascón, Tomás & Oliva-Moreno, Juan & del Cura-González, María Isabel & Domínguez-Bidagor, Julia & Beamud-Lagos, Milagros & Sanz-Cuesta, Teresa, 2010. "Perception of the economic value of primary care services: A willingness to pay study," Health Policy, Elsevier, vol. 94(3), pages 266-272, March.
    2. Laia Palència & Albert Espelt & Maica Rodríguez-Sanz & Katia B. Rocha & M. Isabel Pasarín & Carme Borrell, 2013. "Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 211-219, April.
    3. Holst, Jens, 2010. "Patient cost sharing: Reforms without evidence. Theoretical considerations and empirical findings from industrialized countries," Discussion Papers, Research Group Public Health SP I 2010-303, Social Science Research Center Berlin (WZB).
    4. Mahiben Maruthappu & Robert A. Watson & Johnathan Watkins & Callum Williams & Thomas Zeltner & Omar Faiz & Raghib Ali & Rifat Atun, 2016. "Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990–2009," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(1), pages 119-130, January.
    5. repec:eee:hepoli:v:121:y:2017:i:5:p:543-552 is not listed on IDEAS
    6. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    7. Tambor, Marzena & Pavlova, Milena & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2013. "The formal–informal patient payment mix in European countries. Governance, economics, culture or all of these?," Health Policy, Elsevier, vol. 113(3), pages 284-295.
    8. Poulsen, Camilla Aavang, 2014. "Introducing out-of-pocket payment for General Practice in Denmark: Feasibility and support," Health Policy, Elsevier, vol. 117(1), pages 64-71.
    9. repec:spr:soinre:v:135:y:2018:i:1:d:10.1007_s11205-016-1483-2 is not listed on IDEAS

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