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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Out-of-pocket payments in the Austrian healthcare system – a distributional analysis

Authors: Alice Sanwald, Engelbert Theurl

Published in: International Journal for Equity in Health | Issue 1/2015

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Abstract

Background

Out-of-pocket spending is an important source of healthcare financing even in countries with established prepaid financing of healthcare. However, out-of-pocket payments (OOPP) may have undesirable effects from an equity perspective. In this study, we analyse the distributive effects of OOPP in Austria based on cross-sectional information from the Austrian Household Budget Survey 2009/10.

Methods

We combine evidence from disaggregated measures (concentration curve and Lorenz curve) and summary indices (Gini coefficient, Kakwani index, and Reynolds–Smolensky index) to demonstrate the distributive effects of total OOPP and their subcomponents. Thereby, we use different specifications of household ability to pay. We follow the Aronson–Johnson–Lampert approach and split the distributive effect into its three components: progressivity, horizontal equity, and reranking.

Results

OOPP in Austria have regressive effects on income distribution. These regressive effects are especially pronounced for the OOPP category prescription fees and over-the-counter pharmaceuticals. Disaggregated evidence shows that the effects differ between income groups. The decomposition analysis reveals a high degree of reranking and horizontal inequity for total OOPP, and particularly, for therapeutic aids and physician services.

Conclusions

The results – especially those for prescription fees and therapeutic aids – are of high relevance for the recent and on-going discussion on the reform of benefit catalogues and cost-sharing schemes in the public health insurance system in Austria.
Footnotes
1
Our calculations show that owing to the comprehensive level of public healthcare coverage, the problem of catastrophic healthcare expenditure is of low priority in Austria. The percentage of households with OOPP shares above predefined income thresholds is not related strongly to household ATP. Approximately 9 % of households exceed the 2 % threshold, 4.3 % exceed the 5 % threshold, and 1.6 % exceed the 10 % threshold. We expect this percentages to decrease if the accounting period is increased.
 
2
Households which have a negative ATP II are given an ATP II of zero in the calculations.
 
3
Pharmaceuticals consumed within inpatient treatment are free for the patient. Their financing is included in the DRG-based hospital financing system, and there is no prescription fee.
 
4
If the price of the pharmaceutical is below the prescription fee, the patients pay the price of the pharmaceutical.
 
5
Exemptions are granted without application for (a) retired people who draw small pensions from public pension plans, (b) people with notifiable communicable diseases, (c) members of the civilian service, including their relatives, and (d) asylum seekers. On application, exemptions from the prescription fees are granted for insurance members (including co-insured household members), each with a household net income below the threshold values of the basic income maintenance system.
 
6
If patients consume outpatient medical services supplied by private physicians, pharmaceuticals are paid by the public health insurance system on request, and the system of prescription fees is applied in a similar way.
 
7
Expenditure from OTC pharmaceuticals can result from publicly or privately provided medical treatment. Private health insurance plays only a very limited role in financing pharmaceuticals.
 
8
We abstain from showing the redistributive effects of the OOPP category “other expenditure” because it includes a heterogeneous mix of different expenditure items.
 
9
Thereby, we are aware that in distributional matters, the individual rather than the household is regarded as the relevant unit and, correspondingly, individuals have to be ranked in ascending order according to their household ATP. This is analogous to weighting the household ATP by the number of household members [29, 30].
 
10
This result is in line with those of comparable studies on the income distribution in Austria [27]
 
11
Ungrouped data are needed for the decomposition of RE into V, R, and H [20].
 
12
The proportional cost sharing of members of the health insurance for public workers, employers, and farmers is excluded in this assessment.
 
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Metadata
Title
Out-of-pocket payments in the Austrian healthcare system – a distributional analysis
Authors
Alice Sanwald
Engelbert Theurl
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0230-7

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