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The European Journal of Health Economics
Published in: The European Journal of Health Economics 4/2017

Open Access 01-05-2017 | Original Paper

Out-of-pocket expenditures for pharmaceuticals: lessons from the Austrian household budget survey

Authors: Alice Sanwald, Engelbert Theurl

Published in: The European Journal of Health Economics | Issue 4/2017

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Abstract

Background

Paying pharmaceuticals out of pocket is an important source of financing pharmaceutical consumption. Only limited empirical knowledge is available on the determinants of these expenditures.

Objectives

In this article we analyze which characteristics of private households influence out-of-pocket pharmaceutical expenditure (OOPPE) in Austria.

Design and methods

We use cross-sectional information on OOPPE and household characteristics provided by the Austrian household budget survey 2009/10. We split pharmaceutical expenditures into the two components prescription fees and over-the-counter (OTC) expenditures. To adjust for the specific characteristics of the data, we compare different econometric approaches: a two-part model, hurdle model, generalized linear model and zero-inflated negative binomial regression model.

Findings

The finally selected econometric approaches give a quite consistent picture. The probability of expenditures of both types is strongly influenced by the household structure. It increases with age, doctoral visits and the presence of a female householder. The education level and income only increase the probability of OTC pharmaceuticals. The level of OTC expenditures remains widely unexplained while the household structure and age influence the expenditures for prescription fees. Insurance characteristics of private households, either private or public, play a minor role in explaining the expenditure levels in all specifications. This refers to a homogeneous and comprehensive provision of pharmaceuticals in the public part of the Austrian health care system.

Conclusions

The article gives useful insights into the determinants of pharmaceutical expenditures of private households and supplements the previous research that focuses on the individual level.
Appendix
Available only for authorised users
Footnotes
1
Thereby, the public health insurance consists of different sickness funds. They are separated by territorial and occupational characteristics and have restricted autonomy in defining the terms of consumption of publicly paid health-care services. Workers in the private sector (76 % of the population) are covered by nine sickness funds operating at the level of the nine provinces (named GKK in our tables later on). Farmers (4 %; sickness fund named SVB), employers (8 %; sickness fund named SVA) and public workers (8 %; sickness fund named BVA) are covered by nationwide operating insurance institutions.
 
2
In 2009 the total expenditures for pharmaceuticals without obligatory prescription amounted to 526 million euros [12 % of the total pharmaceutical market (hospitals excluded)]. Eight percent of the expenditures for these products is refunded by the social health insurance system [27].
 
3
Information from 2012; for details, see Versicherungsverband Österreich [32].
 
4
No direct information on the public health insurance status of household members is provided in the household survey. We derive the insurance status from occupational characteristics of the household members. This might lead to minor blurring.
 
5
According to the results of Cook’s distance, we excluded 12 observations and based our findings of the GLM on 5775 households.
 
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Metadata
Title
Out-of-pocket expenditures for pharmaceuticals: lessons from the Austrian household budget survey
Authors
Alice Sanwald
Engelbert Theurl
Publication date
01-05-2017
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 4/2017
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-016-0797-y

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