IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0216386.html
   My bibliography  Save this article

Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema

Author

Listed:
  • Gregoire Mercier
  • Jenica Pastor
  • Valerie Clément
  • Ulysse Rodts
  • Christine Moffat
  • Isabelle Quéré

Abstract

Out-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. We measured the lymphedema-specific outpatient out-of-pocket payments over 6 months. The vertical equity of out-of-pocket payments was examined using concentration curves, the Gini coefficient for income, the Kakwani index, and the Reynolds-Smolensky index. We included 231 lymphedema patients aged 7 years or more, living in metropolitan France, and being able to use Internet and email. After voluntary health insurance reimbursement, the mean out-of-pocket payment was equal to 101.4 Euros per month, mainly due to transport (32%) and medical devices (26%). Concentration curves indicated regressivity of out-of-pocket payments. Total out-of-pocket payments represented 10.1% of the income by consumption unit for the poorest quintile and 3.5% for the wealthiest (p

Suggested Citation

  • Gregoire Mercier & Jenica Pastor & Valerie Clément & Ulysse Rodts & Christine Moffat & Isabelle Quéré, 2019. "Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-13, May.
    • Handle: RePEc:plo:pone00:0216386
    DOI: 10.1371/journal.pone.0216386
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216386
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0216386&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0216386?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. Doorslaer, Eddy van & Wagstaff, Adam & Rutten, Frans (ed.), 1992. "Equity in the Finance and Delivery of Health Care: An International Perspective," OUP Catalogue, Oxford University Press, number 9780192622914.
    2. Wagstaff, Adam, 2008. "Measuring financial protection in health," Policy Research Working Paper Series 4554, The World Bank.
    3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    4. Pierre-Yves Geoffard & Grégoire de Lagasnerie, 2012. "Réformer le système de remboursement pour les soins de ville, une analyse par microsimulation," Économie et Statistique, Programme National Persée, vol. 455(1), pages 89-113.
    5. Alice Sanwald & Engelbert Theurl, 2015. "Out-of-pocket payments in the Austrian healthcare system - a distributional analysis," Working Papers 2015-05, Faculty of Economics and Statistics, Universität Innsbruck.
    6. Julie Chevalier & Gérard Pouvourville, 2013. "Valuing EQ-5D using Time Trade-Off in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 57-66, February.
    7. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1989. "Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 5(1), pages 89-112, Spring.
    8. Terry N. Flynn & Elisabeth Huynh & Tim J. Peters & Hareth Al‐Janabi & Sam Clemens & Alison Moody & Joanna Coast, 2015. "Scoring the Icecap‐a Capability Instrument. Estimation of a UK General Population Tariff," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 258-269, March.
    9. Smith, Peter C., 2005. "User charges and priority setting in health care: balancing equity and efficiency," Journal of Health Economics, Elsevier, vol. 24(5), pages 1018-1029, September.
    10. repec:dau:papers:123456789/9221 is not listed on IDEAS
    11. Claire Lachaud-Fiume & Christine Largeron-Leténo & Lise Rochaix-Ranson, 1998. "Franchise sur les soins ambulatoires et équité sociale," Économie et Statistique, Programme National Persée, vol. 315(1), pages 51-72.
    12. Mackenbach, Johan P., 2012. "The persistence of health inequalities in modern welfare states: The explanation of a paradox," Social Science & Medicine, Elsevier, vol. 75(4), pages 761-769.
    13. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
    14. repec:dau:papers:123456789/9219 is not listed on IDEAS
    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. Grégoire Mercier & Jenica Pastor & Valérie Clément & Ulysse Rodts & Christine Moffat & Isabelle Quéré, 2019. "Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema," Post-Print hal-02862217, HAL.
    2. repec:bla:glopol:v:8:y:2017:i:s2:p:123-130 is not listed on IDEAS
    3. Mohammad Hajizadeh & Luke Brian Connelly & James Robert Gerard Butler, 2014. "Health Policy and Equity of Health Care Financing in Australia: 1973–2010," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 60(2), pages 298-322, June.
    4. 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.
    5. Bilger, Marcel, 2008. "Progressivity, horizontal inequality and reranking caused by health system financing: A decomposition analysis for Switzerland," Journal of Health Economics, Elsevier, vol. 27(6), pages 1582-1593, December.
    6. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.
    7. 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.
    8. 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.
    9. Ulf‐ G. Gerdtham, 1997. "Equity in Health Care Utilization: Further Tests Based on Hurdle Models and Swedish Micro Data," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 303-319, May.
    10. 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.
    11. Jay Dev Dubey, 2021. "Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression Approach," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(4), pages 767-793, December.
    12. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    13. Pavlova, Milena & Groot, Wim & van Merode, Godefridus, 2002. "Public attitudes towards patient payments in Bulgarian public health care sector: results of a household survey," Health Policy, Elsevier, vol. 59(1), pages 1-24, January.
    14. Danyliv, Andriy & Groot, Wim & Gryga, Irena & Pavlova, Milena, 2014. "Willingness and ability to pay for physician services in six Central and Eastern European countries," Health Policy, Elsevier, vol. 117(1), pages 72-82.
    15. Richard Layte & Brian Nolan, 2004. "Equity in the Utilisation of Health Care in Ireland," The Economic and Social Review, Economic and Social Studies, vol. 35(2), pages 111-134.
    16. Panos Kanavos & Olivier Wouters & Anna Zawada & Katarzyna Kolasa & Christian Kronborg & Daniel Rabczenko & Tomasz Rybnik & Jørgen T. Lauridsen & Urszula Ceglowska & Tomasz Hermanowski, 2017. "A Comparison of the Burden of Out-of-Pocket Health Payments in Denmark, Germany and Poland," Global Policy, London School of Economics and Political Science, vol. 8, pages 123-130, March.
    17. Pandey, Anamika & Clarke, Lynda & Dandona, Lalit & Ploubidis, George B., 2018. "Inequity in out-of-pocket payments for hospitalisation in India: Evidence from the National Sample Surveys, 1995–2014," Social Science & Medicine, Elsevier, vol. 201(C), pages 136-147.
    18. Pia Schneider & Kara Hanson, 2006. "Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro‐health insurance and user fees in Rwanda," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 19-31, January.
    19. Ana I. Balsa & Máximo Rossi & Patricia Triunfo, 2011. "Horizontal Inequity in Access to Health Care in Four South American Cities," Revista de Economía del Rosario, Universidad del Rosario, June.
    20. André, Christine, 2015. "Les systèmes de santé européens en longue période," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 17.
    21. Mohammad Hajizadeh & Luke B. Connelly & James R.G. Butler & Aredshir Khosravi, 2012. "Unmet need and met unneed in health care utilisation in Iran," International Journal of Social Economics, Emerald Group Publishing Limited, vol. 39(6), pages 400-422, May.

    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:pone00:0216386. 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.