Associations of lack of voluntary private insurance and out-of-pocket expenditures with health inequalities. Evidence from an international longitudinal survey in countries with universal health coverage.

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State: Public
Version: author
Serval ID
serval:BIB_35F42A0948A2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Associations of lack of voluntary private insurance and out-of-pocket expenditures with health inequalities. Evidence from an international longitudinal survey in countries with universal health coverage.
Journal
PloS one
Author(s)
Baggio S., Dupuis M., Wolff H., Bodenmann P.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
13
Number
10
Pages
e0204666
Language
english
Notes
Publication types: Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
In countries with universal health coverage (UHC), national public health insurances cover 70% of health expenditures on average, but health care user fees and out-of-pocket expenditures have been neglected in empirical patient-centered health inequality research. This study is the first to investigate how health care-related factors are associated with health status among middle-aged and elderly people-vulnerable groups for the burden of illness-in countries with UHC.
Longitudinal observational cohort study.
Population-based cohort Survey of Health, Ageing and Retirement in Europe (SHARE) in twelve countries with UHC.
Non-institutionalized people aged 50 and older (n = 29,260). Two subsamples were also used: participants without global activity limitation at baseline (n = 16,879) and participants without depression at baseline (n = 21,178).
Risk of death, risk of global activity limitations, and risk of depression. We used mixed-effects Cox proportional hazards regressions to estimate hazard ratios (HR) for all-cause mortality, physical limitations, and depression.
Having a voluntary private insurance to cover health expenses not included in the public health care system (44.1% of the total sample) was a protective factor for all outcomes (HR≤0.91), controlling for a large range of socio-economic variables. On the contrary, having out-of-pocket expenditures (62.4%) was a risk factor (HR≥1.12).
UHC systems are not free from health inequalities: there is a potential effect of lack of voluntary private insurance and out-of-pocket expenditures on mortality and health. Health care-related factors should be at focus in future researches designed to understand and address health inequalities. Reducing out-of-pocket expenditures and developing voluntary private insurance may protect against premature illness and death.
Keywords
Aged, Aged, 80 and over, Cohort Studies, Europe, Female, Financing, Personal/economics, Health Expenditures, Health Status Disparities, Humans, Insurance, Health/economics, Longitudinal Studies, Male, Middle Aged, Universal Health Insurance/economics
Pubmed
Web of science
Open Access
Yes
Create date
10/10/2018 12:05
Last modification date
20/08/2019 14:23
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