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Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries

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  • Jelena Arsenijevic
  • Milena Pavlova
  • Bernd Rechel
  • Wim Groot

Abstract

Introduction: It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. Methods: The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. Results: We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. Discussion: Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.

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  • Jelena Arsenijevic & Milena Pavlova & Bernd Rechel & Wim Groot, 2016. "Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-18, July.
    • Handle: RePEc:plo:pone00:0157765
    DOI: 10.1371/journal.pone.0157765
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    2. Jonila Gabrani & Christian Schindler & Kaspar Wyss, 2022. "Out of pocket payments and access to NCD medication in two regions in Albania," PLOS ONE, Public Library of Science, vol. 17(8), pages 1-16, August.
    3. Samuel López-López & Raúl del Pozo-Rubio & Marta Ortega-Ortega & Francisco Escribano-Sotos, 2021. "Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain," IJERPH, MDPI, vol. 18(3), pages 1-18, January.
    4. Peter Gan Kim Soon & Sanjay Rampal & Soo Kun Lim & Tin Tin Su, 2023. "Effect of socioeconomic status and healthcare provider on post-transplantation care in Malaysia: A multi-centre survey of kidney transplant recipients," PLOS ONE, Public Library of Science, vol. 18(4), pages 1-15, April.
    5. Kyriopoulos, Ilias & Nikoloski, Zlatko & Mossialos, Elias, 2021. "Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession," Health Policy, Elsevier, vol. 125(9), pages 1256-1266.
    6. Raúl Pozo-Rubio & Román Mínguez-Salido & Isabel Pardo-García & Francisco Escribano-Sotos, 2019. "Catastrophic long-term care expenditure: associated socio-demographic and economic factors," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 691-701, July.
    7. Sabine Vogler & Guillaume Dedet & Hanne Bak Pedersen, 2019. "Financial Burden of Prescribed Medicines Included in Outpatient Benefits Package Schemes: Comparative Analysis of Co-Payments for Reimbursable Medicines in European Countries," Applied Health Economics and Health Policy, Springer, vol. 17(6), pages 803-816, December.
    8. Anamika Pandey & G Anil Kumar & Rakhi Dandona & Lalit Dandona, 2018. "Variations in catastrophic health expenditure across the states of India: 2004 to 2014," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-15, October.
    9. Indrani Gupta & Arjun Roy, 2021. "Including musculoskeletal diseases in the health policy agenda in India Evidence on burden and economic impact on Indian households," IEG Working Papers 432, Institute of Economic Growth.
    10. Ahmed Abdelmajed Alkhodary & Syed Mohamed Aljunid & Aniza Ismail & Amrizal Muhammad Nur & Suzana Shahar, 2022. "Health Care Utilization and Out-of-Pocket Payments among Elderly with Cognitive Frailty in Malaysia," IJERPH, MDPI, vol. 19(6), pages 1-18, March.
    11. Leila Zarei & Iman Karimzadeh & Najmeh Moradi & Payam Peymani & Sara Asadi & Zaheer-Ud-Din Babar, 2020. "Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines," IJERPH, MDPI, vol. 17(5), pages 1-19, March.
    12. Raúl Pozo-Rubio & Marta Ortega-Ortega, 2022. "Sociodemographic and health factors associated with the risk of financial catastrophe when informal care for patients with haematological neoplasms is replaced by formal care," Health Economics Review, Springer, vol. 12(1), pages 1-12, December.
    13. Maria-Carmen García-Centeno & Román Mínguez-Salido & Raúl del Pozo-Rubio, 2021. "The Classification of Profiles of Financial Catastrophe Caused by Out-of-Pocket Payments: A Methodological Approach," Mathematics, MDPI, vol. 9(11), pages 1-20, May.
    14. Samuel López-López & Raúl Pozo-Rubio & Marta Ortega-Ortega & Francisco Escribano-Sotos, 2022. "Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1187-1201, September.
    15. Connolly, Sheelah & Wren, Maev-Ann, 2023. "Towards universal healthcare in Ireland – what can we learn from the literature?," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT121.
    16. Veronika Kočiš Krůtilová, 2021. "The out‐of‐pocket medication burden: Which health problems impact the Czech population aged 50+?," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2129-2144, November.
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