IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v17y2020i21p8156-d440002.html
   My bibliography  Save this article

The Determinants of Out-of-Pocket Expenditure in IBD Italian Patients. Results from the AMICI Survey

Author

Listed:
  • Matteo Ruggeri

    (National Center for HTA, Istituto Superiore di Sanità, 00161 Rome, Italy
    School of Medicine, St. Camillus International University of Health Sciences, 00131 Rome, Italy)

  • Carlo Drago

    (Faculty of Economics, Università Niccolò Cusano, 00166 Rome, Italy)

  • Chiara Cadeddu

    (School of Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy)

  • Alessandro Armuzzi

    (School of Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
    Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy)

  • Salvo Leone

    (Amici Italia Onlus, 20125 Milan, Italy)

  • Marco Marchetti

    (National Center for HTA, Istituto Superiore di Sanità, 00161 Rome, Italy)

Abstract

Decision makers are used to consider Out-of-Pocket Expenditure (OOPE) within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system. In this paper, we provide estimates on the determinants of OOPE in Italy by using data coming from an observational cross-sectional study that enrolled a sample of 2526 patients suffering from inflammatory bowel diseases. We explore the association between OOPE and: (1) geographical location; (2) income effects; (3) performances in delivering healthcare. A regression model was used. Individuals’ age were in the range of 18–88 (mean 44 ± 14.55). Forty-six percent were females, 54% were married and 19% held a bachelor degree. Ninety-six percent of respondents declared an OOPE >0 whose mean value was €960 ± €950. Individuals belonging to low-income and low-performance regions were more likely to declare an OOPE >0 (99%). Regression findings suggest that increases in OOPE could be considered as a response from patients aiming to compensate for lacks and inefficiencies in the public healthcare offers. Policymakers should consider increases in OOPE in patients with Inflammatory Bowel Diseases (IBDs) as an indicator of poor quality of care and poor fairness.

Suggested Citation

  • Matteo Ruggeri & Carlo Drago & Chiara Cadeddu & Alessandro Armuzzi & Salvo Leone & Marco Marchetti, 2020. "The Determinants of Out-of-Pocket Expenditure in IBD Italian Patients. Results from the AMICI Survey," IJERPH, MDPI, vol. 17(21), pages 1-14, November.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:21:p:8156-:d:440002
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/17/21/8156/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/17/21/8156/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Ruggeri, Matteo & Drago, Carlo & Moramarco, Vincenzo & Coretti, Silvia & Köppen, Julia & Islam, Muhammad Kamrul & Gibson, Jonathan & Busse, Reinhard & van Exel, Job & Sutton, Matthew & Askildsen, Jan , 2018. "New professional roles and patient satisfaction: Evidence from a European survey along three clinical pathways," Health Policy, Elsevier, vol. 122(10), pages 1078-1084.
    2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    3. Joan Costa-Font & Panos Kanavos & Joan Rovira, 2007. "Determinants of out-of-pocket pharmaceutical expenditure and access to drugs in Catalonia," Applied Economics, Taylor & Francis Journals, vol. 39(5), pages 541-551.
    4. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, vol. 18(3), pages 263-290, June.
    5. Newhouse, Joseph P., 1987. "Cross national differences in health spending what do they mean?," Journal of Health Economics, Elsevier, vol. 6(2), pages 159-162, June.
    6. Adrian Xi Lin & Andrew Fu Wah Ho & Kang Hao Cheong & Zengxiang Li & Wentong Cai & Marcel Lucas Chee & Yih Yng Ng & Xiaokui Xiao & Marcus Eng Hock Ong, 2020. "Leveraging Machine Learning Techniques and Engineering of Multi-Nature Features for National Daily Regional Ambulance Demand Prediction," IJERPH, MDPI, vol. 17(11), pages 1-15, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hai Zhong, 2010. "The impact of missing data in the estimation of concentration index: a potential source of bias," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 255-266, June.
    2. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    3. De Matteis, Domenico & Ishizaka, Alessio & Resce, Giuliano, 2019. "The ‘postcode lottery’ of the Italian public health bill analysed with the hierarchy Stochastic Multiobjective Acceptability Analysis," Socio-Economic Planning Sciences, Elsevier, vol. 68(C).
    4. Mohammad Hajizadeh & Hong Nghiem, 2011. "Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 267-285, December.
    5. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2016. "Out of pocket payments and social health insurance for private hospital care: Evidence from Greece," Health Policy, Elsevier, vol. 120(8), pages 948-959.
    6. Gemini Mtei & Josephine Borghi & Kara Hanson, 2015. "Predicting Consumption Expenditure for the Analysis of Health Care Financing Equity in Low Income Countries: a Comparison of Approaches," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 124(2), pages 339-355, November.
    7. Hai Zhong, 2010. "On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?," International Journal of Health Economics and Management, Springer, vol. 10(4), pages 369-386, December.
    8. Cinaroglu, Songul, 2024. "Trends in out-of-pocket health expenditure inequality in Turkey under comprehensive health reforms," World Development Perspectives, Elsevier, vol. 34(C).
    9. Jacobs, Paul D. & Hill, Steven C., 2024. "Horizontal and vertical equity and public subsidies for private health insurance in the U.S," Social Science & Medicine, Elsevier, vol. 351(C).
    10. Gabriel M. Leung & Keith Y. K. Tin & Owen O'Donnell, 2009. "Redistribution or horizontal equity in Hong Kong's mixed public–private health system: a policy conundrum," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 37-54, January.
    11. Mônica Viegas Andrade & Kenya Valéria M. de Souza Noronha & Abhishek Singh & Cristina Guimarães Rodrigues & Sabu S. Padmadas, 2011. "Equidade na utilização dos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras no período 1998-2008," Textos para Discussão Cedeplar-UFMG td446, Cedeplar, Universidade Federal de Minas Gerais.
    12. Sterling Edmonds & Mohammad Hajizadeh, 2019. "Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010–2015," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(7), pages 1001-1011, September.
    13. Robson, Matthew & O’Donnell, Owen & Van Ourti, Tom, 2024. "Aversion to health inequality — Pure, income-related and income-caused," Journal of Health Economics, Elsevier, vol. 94(C).
    14. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    15. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & Citoni, Guido & Di Biase, Rita & Gerdtham, Ulf-G. & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "The redistributive effect of health care finance in twelve OECD countries," Journal of Health Economics, Elsevier, vol. 18(3), pages 291-313, June.
    16. Nora Lustig & Florencia Amábile & Marisa Bucheli & George Gray Molina & Sean Higgins & Miguel Jaramillo & Wilson Jiménez Pozo & Veronica Paz Arauco & Claudiney Pereira & Carola Pessino & Máximo Rossi , 2014. "El impacto del sistema tributario y del gasto social sobre la desigualdad y la pobreza en Argentina, Bolivia, Brasil, México, Perú y Uruguay: Un panorama general," Commitment to Equity (CEQ) Working Paper Series 1313S, Tulane University, Department of Economics.
    17. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    18. Ahmed Shoukry Rashad, 2014. "The Catastrophic Economic Consequences of Illness and their Effect on Poverty Estimates in Egypt, Jordan, and Palestine," Working Papers 842, Economic Research Forum, revised Oct 2014.
    19. Kinyondo, Abel Alfred & Ntegwa, Magashi Joseph & Masawe, Cresencia Apolinary, 2022. "Socioeconomic Inequality in Maternal Healthcare Services: The Case of Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 10(1), January.
    20. Rahman, Md Mizanur & Jung, Jenny & Islam, Md Rashedul & Rahman, Md Mahfuzur & Nakamura, Ryota & Akter, Shamima & Sato, Motohiro, 2022. "Global, regional, and national progress in financial risk protection towards universal health coverage, 2000–2030," Social Science & Medicine, Elsevier, vol. 312(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:17:y:2020:i:21:p:8156-:d:440002. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.