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What Interventions Work to Reduce Cost Barriers to Primary Healthcare in High-Income Countries? A Systematic Review
Bailey Yee1, Nisa Mohan1, Fiona McKenzie1
1Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, Wellington 6011, New Zealand.
Summary
Eliminating out-of-pocket payments for primary healthcare significantly boosts service use and can lead to system-wide savings. This review explores interventions to reduce cost barriers in high-income countries.
Area of Science:
- Health Services Research
- Public Health Policy
Background:
- High-income countries face challenges with equitable healthcare access.
- Out-of-pocket payments for healthcare can lead to reduced service utilization, poorer health outcomes, and financial hardship.
Approach:
- Systematic review of studies published in English from 2000 to May 2022.
- Searched three bibliographic databases: Dimensions, Embase, and Medline Web of Science.
- Included 43 publications involving over 18 million participants and 6,800 practices, assessing interventions to reduce primary healthcare cost barriers.
Key Points:
- Interventions included removing out-of-pocket costs, nonprofit programs, additional workforce, and alternative payment methods.
- Eliminating or reducing out-of-pocket costs substantially increased healthcare utilization.
- Initiatives generally reported financial savings at the system level.
Conclusions:
- Health system initiatives aimed at reducing cost barriers are generally associated with improved access to primary healthcare services.
- Further research may be needed to understand the consistent association between these initiatives and improved access.
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