The out-of-pocket burden of chronic diseases: the cases of Belgian, Czech and German older adults.
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ABSTRACT: Background
Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium, the Czech Republic and Germany.Methods
Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe is used. A two-part model with a logit model in the first part and a generalised linear model in the second part is applied.Results
The diseases increasing the burden in the observed countries are heart attacks, high blood pressure, cancer, emotional disorders, rheumatoid arthritis and osteoarthritis. Reflecting country differences Parkinson's disease and its drug burden is relevant in Belgium, the drugs burden related to heart attack and outpatient care burden to chronic kidney disease in the Czech Republic and the outpatient care burden of cancer and chronic lung disease in Germany. In addition, we confirm the regressive character of out-of-pocket payments.Conclusions
We conclude that the burden is not equitably distributed among older adults with chronic diseases. Identification of chronic diseases with a high burden can serve as a supplementary protective feature.
SUBMITTER: Kocis Krutilova V
PROVIDER: S-EPMC7967967 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
Publications
The out-of-pocket burden of chronic diseases: the cases of Belgian, Czech and German older adults.
Kočiš Krůtilová Veronika V Bahnsen Lewe L De Graeve Diana D
BMC health services research 20210317 1
<h4>Background</h4>Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium, the Czech Republic and Germany.<h4>Methods</h4>Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe is used. A ...[more]
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Project description:AimsTo evaluate the prevalence of chronic diseases (CDs) among older patients in German general practices (GPs).MethodsA total of 840,319 patients older than 65 years (359,289 male and 481,030 female) who consulted a GP between January and December 2014 were selected. Ten different CDs were considered: hypertension, lipid metabolism, diabetes, coronary heart disease, cancer, chronic obstructive pulmonary disease, heart failure, stroke, chronic kidney disease and osteoporosis. The prevalence, defined as the proportion of patients diagnosed with these disorders, was estimated.ResultsAll CDs were very common in older subjects. Hypertension was the most common CD, affecting 65.7% of men and 66.1% of women. Stroke was the least frequent CD, with 6.6% of men and 5.1% of women displaying this condition. More than one out of two subjects had between one and three CDs (men: 57.7% and women: 59.3%). Approximately 25% of subjects had four or more CDs (men: 26.6% and women: 23.6%).ConclusionsOur study showed that the prevalence of CDs is high in the German elderly population. Hypertension was the most frequent chronic condition and around 25% of patients displayed at least four CDs.
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Project description:BackgroundThe Affordable Care Act (ACA) aims to expand coverage and increase access to health insurance. Despite the increase of insured individuals, there are a number of concerns about whether coverage and care are affordable. Prior studies document a growing concern with rising premiums and cost-sharing, including deductibles, particularly for those with chronic conditions.ObjectiveCompare the ACA marketplace plan availability and costs across 17 states for individuals with varying diabetic engagement profiles and their related medical needs.DesignDescriptive Cost Analysis.MethodsUsing Healthcare.gov individual state marketplace websites, we utilized a descriptive cost analysis to compare plan availability and costs for premiums, deductibles, co-payments, and co-insurance for an individual aged 63 years old, who was either a non-diabetic, high-engagement or low-engagement diabetic in urban and rural areas. Using the second lowest monthly premium silver plan (the benchmark plan), we calculated annual costs for premiums, co-insurance, co-payments, and deductibles for these individual profiles. We assessed statistical differences between health care component costs, within and across urban and rural areas, using t-tests.ResultsThe findings highlight within and across states, individuals with diabetes, particularly low-engagement diabetics, spend a significantly higher percent of their income on additional health care costs, above their premium, than non-diabetic individuals. In some states, low-engagement diabetic patients spend upwards of 3 times more than high-engagement diabetic patients, highlighting an additional cost burden. For low-engagement diabetics, deductibles are driving health care spending with an average of 59% of health care spending coming from deductible payments. Results do not show statistically different costs across urban and rural diabetic patients.ConclusionDespite the ACA's success, results highlight variation in plan availability across states and disproportionate cost burden placed on moderate income individuals, especially related to deductible, and co-payments for those with chronic diseases.
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Project description:ImportanceMedicare beneficiaries with cancer are at risk for financial hardship given increasingly expensive cancer care and significant cost sharing by beneficiaries.ObjectivesTo measure out-of-pocket (OOP) costs incurred by Medicare beneficiaries with cancer and identify which factors and services contribute to high OOP costs.Design, setting, and participantsWe prospectively collected survey data from 18 166 community-dwelling Medicare beneficiaries, including 1409 individuals who were diagnosed with cancer during the study period, who participated in the January 1, 2002, to December 31, 2012, waves of the Health and Retirement Study, a nationally representative panel study of US residents older than 50 years. Data analysis was performed from July 1, 2014, to June 30, 2015.Main outcomes and measuresOut-of-pocket medical spending and financial burden (OOP expenditures divided by total household income).ResultsAmong the 1409 participants (median age, 73 years [interquartile range, 69-79 years]; 46.4% female and 53.6% male) diagnosed with cancer during the study period, the type of supplementary insurance was significantly associated with mean annual OOP costs incurred after a cancer diagnosis ($2116 among those insured by Medicaid, $2367 among those insured by the Veterans Health Administration, $5976 among those insured by a Medicare health maintenance organization, $5492 among those with employer-sponsored insurance, $5670 among those with Medigap insurance coverage, and $8115 among those insured by traditional fee-for-service Medicare but without supplemental insurance coverage). A new diagnosis of cancer or common chronic noncancer condition was associated with increased odds of incurring costs in the highest decile of OOP expenditures (cancer: adjusted odds ratio, 1.86; 95% CI, 1.55-2.23; P < .001; chronic noncancer condition: adjusted odds ratio, 1.82; 95% CI, 1.69-1.97; P < .001). Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that were a mean of 23.7% of their household income; 10% of these beneficiaries incurred OOP expenditures that were 63.1% of their household income. Among the 10% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 41.6% of total OOP costs.Conclusions and relevanceMedicare beneficiaries without supplemental insurance incur significant OOP costs following a diagnosis of cancer. Costs associated with hospitalization may be a primary contributor to these high OOP costs. Medicare reform proposals that restructure the benefit design for hospital-based services and incorporate an OOP maximum may help alleviate financial burden, as can interventions that reduce hospitalization in this population.
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Project description:BackgroundOut-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care.MethodsA systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs.ResultsAmong all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively.ConclusionsWe found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
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Project description:IntroductionThis study aims to determine the out-of-pocket health expenditures of households in Turkey where individuals with rare diseases are residing.MethodsThe research population consisted registered members of associations who are members of the Rare Diseases Network. In addition to the general analysis including all participants, expenditures based on characteristics of disease holders were also calculated.ResultsA total of 439 participants were included in the analysis. We determined that special nutrition was the highest expenditure group and emergency departments were the lowest expenditure group. When all the participants were evaluated, the average cost of rare diseases was found to be Ł22,743 (€2,877). A significant relationship was found between income status and out-of-pocket health expenditures (p = 0.012).DiscussionPolicy makers should consider inclusion of special nutritional products and medical/non-medical devices used in treatment of rare diseases within the scope of reimbursement and the development of orphan drug legislation as the first actions to be taken.
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