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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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. (co-first), Dupuis M., Wolff Hans, Bodenmann P. (co-last)
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 11:05
Last modification date
22/10/2021 8:51
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