Research
Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review
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* Corresponding author: Sandro Corrieri Sandro.Corrieri@medizin.uni-leipzig.de
- † Equal contributors
1 University of Leipzig, Health Economics Research Unit, Department of Psychiatry, Liebigstr. 26, 04103 Leipzig, Germany
2 Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
3 University of Leipzig, Department of Psychiatry, Semmelweisstr. 10, 04103 Leipzig, Germany
4 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Bergheimer Str. 20, 69115 Heidelberg, Germany
International Journal for Equity in Health 2010, 9:20 doi:10.1186/1475-9276-9-20
Published: 11 August 2010Abstract
Background
In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+.
Methods
Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed.
Results
Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care.
Conclusions
While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous.