IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0157765.html
   My bibliography  Save this article

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

Author

Listed:
  • 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.

Suggested Citation

  • 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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157765
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0157765&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0157765?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Yardim, Mahmut Saadi & Cilingiroglu, Nesrin & Yardim, Nazan, 2010. "Catastrophic health expenditure and impoverishment in Turkey," Health Policy, Elsevier, vol. 94(1), pages 26-33, January.
    2. Jens Ludwig & Greg J. Duncan & Lisa A. Gennetian & Lawrence F. Katz & Ronald C. Kessler & Jeffrey R. Kling & Lisa Sanbonmatsu, 2013. "Long-Term Neighborhood Effects on Low-Income Families: Evidence from Moving to Opportunity," American Economic Review, American Economic Association, vol. 103(3), pages 226-231, May.
    3. Lianne Barnieh & Fiona Clement & Anthony Harris & Marja Blom & Cam Donaldson & Scott Klarenbach & Don Husereau & Diane Lorenzetti & Braden Manns, 2014. "A Systematic Review of Cost-Sharing Strategies Used within Publicly-Funded Drug Plans in Member Countries of the Organisation for Economic Co-Operation and Development," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-10, March.
    4. Hausman, Jerry, 2015. "Specification tests in econometrics," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 38(2), pages 112-134.
    5. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health‐care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412, December.
    6. repec:emc:wpaper:dte-543 is not listed on IDEAS
    7. Donald S. Kenkel & Maximilian D. Schmeiser & Carly Urban, 2014. "Is Smoking Inferior?: Evidence from Variation in the Earned Income Tax Credit," Journal of Human Resources, University of Wisconsin Press, vol. 49(4), pages 1094-1120.
    8. Wagstaff, Adam & Eozenou, Patrick Hoang-Vu, 2014. "CATA meets IMPOV: a unified approach to measuring financial protection in health," Policy Research Working Paper Series 6861, The World Bank.
    9. Hans van Kippersluis & Titus J. Galama, 2013. "Why the Rich drink more but smoke less: The Impact of Wealth on Health Behaviors," Tinbergen Institute Discussion Papers 13-035/V, Tinbergen Institute.
    10. Sargent-Cox, Kerry & Butterworth, Peter & Anstey, Kaarin J., 2011. "The global financial crisis and psychological health in a sample of Australian older adults: A longitudinal study," Social Science & Medicine, Elsevier, vol. 73(7), pages 1105-1112.
    11. Owen Smith & Son Nam Nguyen, 2013. "Getting Better : Improving Health System Outcomes in Europe and Central Asia," World Bank Publications - Books, The World Bank Group, number 13832.
    12. Tambor, Marzena & Pavlova, Milena & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2013. "The formal–informal patient payment mix in European countries. Governance, economics, culture or all of these?," Health Policy, Elsevier, vol. 113(3), pages 284-295.
    13. Abegunde, Dele Olawale & Stanciole, Anderson E., 2008. "The economic impact of chronic diseases: How do households respond to shocks? Evidence from Russia," Social Science & Medicine, Elsevier, vol. 66(11), pages 2296-2307, June.
    14. Jonathan Haughton & Shahidur R. Khandker, 2009. "Handbook on Poverty and Inequality," World Bank Publications - Books, The World Bank Group, number 11985.
    15. Hans van Kippersluis & Titus J. Galama, 2013. "Why the Rich drink more but smoke less: The Impact of Wealth on Health Behaviors," Tinbergen Institute Discussion Papers 13-035/V, Tinbergen Institute.
    16. Łuczak, Julita & García-Gómez, Pilar, 2012. "Financial burden of drug expenditures in Poland," Health Policy, Elsevier, vol. 105(2), pages 256-264.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    15. Yerramilli, Pooja & Fernández, Óscar & Thomson, Sarah, 2018. "Financial protection in Europe: a systematic review of the literature and mapping of data availability," Health Policy, Elsevier, vol. 122(5), pages 493-508.

    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. Arsenijevic, Jelena & Pavlova, Milena & Groot, Wim, 2013. "Measuring the catastrophic and impoverishing effect of household health care spending in Serbia," Social Science & Medicine, Elsevier, vol. 78(C), pages 17-25.
    2. Chantzaras, Athanasios E. & Yfantopoulos, John N., 2018. "Financial protection of households against health shocks in Greece during the economic crisis," Social Science & Medicine, Elsevier, vol. 211(C), pages 338-351.
    3. Nikolaos Grigorakis & Christos Floros & Haritini Tsangari & Evangelos Tsoukatos, 2017. "Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 261-287, September.
    4. Benedicte Apouey & Andrew E. Clark, 2015. "Winning Big but Feeling no Better? The Effect of Lottery Prizes on Physical and Mental Health," Health Economics, John Wiley & Sons, Ltd., vol. 24(5), pages 516-538, May.
    5. Hasan Vergil & Fuat Sekmen & Haşmet Gökirmak & Sukru Apaydin, 2022. "2008 financial crisis and income distribution in Turkey," Quality & Quantity: International Journal of Methodology, Springer, vol. 56(4), pages 2627-2643, August.
    6. Oscar Erixson, 2017. "Health responses to a wealth shock: evidence from a Swedish tax reform," Journal of Population Economics, Springer;European Society for Population Economics, vol. 30(4), pages 1281-1336, October.
    7. repec:hal:pseose:halshs-00566789 is not listed on IDEAS
    8. Johnston, Bridget M. & Burke, Sara & Barry, Sarah & Normand, Charles & Ní Fhallúin, Maebh & Thomas, Steve, 2019. "Private health expenditure in Ireland: Assessing the affordability of private financing of health care," Health Policy, Elsevier, vol. 123(10), pages 963-969.
    9. Ligane Séne & Momath Cissé, 2015. "Catastrophic out-of-pocket payments for health and poverty nexus: evidence from Senegal," International Journal of Health Economics and Management, Springer, vol. 15(3), pages 307-328, September.
    10. Kim, Younhee & Yang, Bongmin, 2011. "Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea," Health Policy, Elsevier, vol. 100(2), pages 239-246.
    11. Adam Wagstaff, 2019. "Measuring catastrophic medical expenditures: Reflections on three issues," Health Economics, John Wiley & Sons, Ltd., vol. 28(6), pages 765-781, June.
    12. Meriem Oudmane & Fouzi Mourji & Abdeljaouad Ezzrari, 2019. "The impact of out‐of‐pocket health expenditure on household impoverishment: Evidence from Morocco," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1569-1585, October.
    13. Raúl Del Pozo-Rubio & Isabel Pardo-García & Francisco Escribano-Sotos, 2020. "Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment," IJERPH, MDPI, vol. 17(1), pages 1-19, January.
    14. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.
    15. Carlos Alberto Belchior & Yara Gomes, 2022. "Liquidity constraints, cash transfers and the demand for health care in the Covid‐19 pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2369-2380, November.
    16. Cinaroglu, Songul, 2024. "Trends in out-of-pocket health expenditure inequality in Turkey under comprehensive health reforms," World Development Perspectives, Elsevier, vol. 34(C).
    17. Ohrnberger, Julius & Anselmi, Laura & Fichera, Eleonora & Sutton, Matt, 2020. "The effect of cash transfers on mental health: Opening the black box – A study from South Africa," Social Science & Medicine, Elsevier, vol. 260(C).
    18. Kronenberg, Christoph & Barros, Pedro Pita, 2014. "Catastrophic healthcare expenditure – Drivers and protection: The Portuguese case," Health Policy, Elsevier, vol. 115(1), pages 44-51.
    19. Ebaidalla Mahjoub Ebaidalla & Mohammed Elhaj Mustafa Ali, 2017. "Determinants and Impact of Households’s Out-of-Pocket Health Care Expenditure in Sudan: Evidence From Urban and Rural Population," Working Papers 1170, Economic Research Forum, revised 12 2017.
    20. repec:cep:sticar:case/96 is not listed on IDEAS
    21. Titus J. Galama & Hans van Kippersluis, 2013. "Health Inequalities through the Lens of Health-Capital Theory: Issues, Solutions, and Future Directions," Research on Economic Inequality, in: Health and Inequality, volume 21, pages 263-284, Emerald Group Publishing Limited.
    22. Mohammadreza Amiresmaili & Zahra Emrani, 2019. "Investigating the exposure of Iranian households to catastrophic health expenditure due to the need to purchase medicines," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-11, April.

    More about this item

    Statistics

    Access and download statistics

    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:plo:pone00:0157765. 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: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    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.