Patient payments in Europe

1. Patient paymentsin Europe Wim Groot Maastricht University Sustainable Financing of Health Care systems March 24-25, 2011, Bucharest

2. Assessment of patient payment policies and projection of their efficiency, equity and quality effects: The case of Central and Eastern EuropeASSPRO CEE 2007http://assprocee2007.com

3. Consortium

4. Research Team • Project coordinator: Milena Pavlova • Scientific coordinators: Wim Groot, Frits van Merode • Researchers: Jelena Arsenijevic, Elka Atanasova, Petra Baji, Andriy Danyliv, Vladimir Gordeev, Tetiana Stepurko, Marzena Tamor, Sonila Tomini

5. For further reference: • M. Tambor, M. Pavlova, P. Woch & W. Groot (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries.European Journal of Public Health. Forthcoming. http://eurpub.oxfordjournals.org/content/early/2010/09/29/eurpub.ckq139.abstract • T. Stepurko, M. Pavlova, I. Gryga & W.Groot (2010).Empirical studies on informal patient payments for health care services: A systematic and critical review of research methods and instruments.BMC Health Services Research 10:273

6. Patient payments • Formal cost-sharing arrangements • Informal payments

7. Formal-informal patient payment mix in Europe

8. Formal and informal payment systems differ by • Recipient • Purpose of payment • Amount of payment • Exemptions and structure of payment

9. Source: Stepurko et al.: Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Services Research 2010, 10:273.

10. Formal cost-sharing arrangements and informal payments seem independent from eachother • Formal cost-sharing does not seem an option to eradicate informal payments

11. Formal cost-sharing policies • To improve efficiency and quality of health care • To contain (public) health care expenditures • To generate revenues for health care • To improve sustainability of health care system

12. Types of cost-sharing Cost-sharing = official arrangement aimed to partially involve the user in the payment for public health care services Four types of cost-sharing • Co-payments • Co-insurance • Deductibles • Reference pricing (extra billing)

13. Basic characteristics of the EU health care systems(2007-2008) Source: Tambor, M., Pavlova, M., Woch, P. & Groot, W. (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. European Journal of Public Health. Forthcoming.

14. Source: OECD Health Data 2006

15. Characteristics health care systems 27 EU countries • Insurance based systems prevail over tax based systems • Three methods of paying for GP’s: capitation, salary and fee-for-service • Medical specialists: fee-for-service and salary • GP gate keeping is rather common • Only in 7 member states patients do not need a referral from a GP

16. Patient cost-sharing arrangements in the EU for three types of services(2007-2008) Source: Tambor, M., Pavlova, M., Woch, P. & Groot, W. (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. European Journal of Public Health. Forthcoming.

17. Characteristics cost-sharing arrangements • In nearly half the member states there are no formal patient cost-sharing arrangements for GP, medical specialists or hospital care • The most common type of cost-sharing for GP is co-payment followed by coinsurance and mixed patient cost-sharing • The same forms of cost-sharing are applied to medical specialists and hospital care • Cost-sharing for pharmaceuticals in EU is more diverse

18. Exemption mechanisms • The majority of EU countries has exemptions in case of low income, age (children, pensioners) or poor medical status • Only 2 countries have no exemptions

19. Patient cost-sharing arrangements in the EU have been changing considerably (mostly being extended) during the last decades and they are quite diverse at present.

20. The dynamics of patient cost-sharing in the EU Source: Tambor, M., Pavlova, M., Woch, P. & Groot, W. (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. European Journal of Public Health. Forthcoming.

21. Relation cost-sharing and financial characteristics health care systems • GP gate keeping does not preclude the application of cost-sharing for physician services and vice versa: without gate-keeping not always cost-sharing for medical specialists • Coinsurance is most common in case of fee-for-service to providers, co-payment goes together with salaries and capitation payment

22. Relation cost-sharing and financial characteristics health care systems • Absence of cost-sharing is most frequent in countries where GP’s are paid capitation and medical specialists are paid fee-for-service • Cost-sharing is slightly more common in countries with insurance systems • In tax based systems co-payments are most frequent for physician and hospital services • In insurance based systems cost-sharing arrangements are more pluralistic • For pharmaceuticals cost-sharing arrangements are diverse in both systems

23. Relation cost-sharing and financial characteristics health care systems No significant relation between exemptions and financial characteristics of health care systems in EU countries

24. Conclusion • Formal and informal patient payments are largely independent from each other • Heterogeneity in patient payment systems within EU • No sign of convergence in patient payments

25. Wim Groot Professor of Health Economics Thank youfor your attention