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Does cost sharing do more harm or more good? - a systematic literature review
Katarzyna Kolasa1, Marta Kowalczyk2
1Health Economics Department, Collegium Medicum Bydgoszcz, Sandomierska 16, 85-630, Bydgoszcz, Poland. kkolasa@wum.edu.pl.
BMC Public Health
|September 17, 2016
Summary
Reducing out-of-pocket (OOP) healthcare payments can improve financial fairness, but requires expanded coverage. Introducing formal OOP fees necessitates protections for vulnerable populations to prevent catastrophic healthcare costs.
Area of Science:
- Health Economics
- Public Health Policy
- Healthcare Financing
Background:
- Out-of-pocket (OOP) payments in healthcare financing present a dual impact: increasing cost awareness but potentially hindering access to care.
- Defining optimal OOP payment structures requires careful consideration of these competing consequences.
Purpose of the Study:
- To identify strategies employed to mitigate the financial burden of OOP healthcare payments.
- To assess the impact of formal OOP payment systems on the fairness of financial contributions to healthcare.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Cochrane).
- Included studies measured the Kakwani index of progressivity at multiple time points (January 2004 - September 2015).
- A change in the Kakwani index exceeding 0.10 was defined as a significant health policy impact.
Main Results:
- 16 publications were analyzed, focusing on OOP burden reduction and the introduction of formal fees.
- Four studies reported significant health policy impacts, all related to reducing OOP burden, shifting payments towards progressivity or regressivity.
- No studies on formal fee introduction reported a significant impact on the regressivity of OOP spending.
Conclusions:
- Health policy impacts on OOP payment distribution were often insignificant.
- Effective OOP burden reduction necessitates expanded healthcare coverage and diverse financing sources.
- Formal fees require safeguards against catastrophic payments for vulnerable groups.
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