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5. ACCESS TO CARE
Out-of-pocket medical expenditure
Financial protection through compulsory or voluntary greater share of household spending (20-32%) on inpatient
health coverage can substantially reduce the amount that care than the OECD average of less than 10%.
people need to pay directly for medical care. Yet in some In some Central and Eastern European countries such as
countries the burden of out-of-pocket spending can still Poland, the Czech Republic and Hungary, as well as Canada
create barriers to health care access and use: households and Mexico, expenditure on pharmaceuticals accounts for
that face difficulties paying medical bills may delay or half or more of all out-of-pocket payments. This may be due
even forgo needed health care. On average across OECD not only to co-payments for prescribed pharmaceuticals,
countries, a fifth of all spending on health care comes but also high levels of spending on over-the-counter
directly from patients (see indicator “Financing of health medicines for self-medication. Therapeutic goods, covering
care”). among other items, corrective eye products and hearing
Out-of-pocket payments rely on the ability to pay. If the aids, can also account for a significant proportion of
financing of health care becomes more dependent on out- household spending. In the case of spectacles, compulsory
of-pocket payments, the burden shifts, in theory, towards coverage is often limited to paying a contribution for the
those who use services more, and possibly from high to cost of the lenses, while private households are left to
low-income earners, where health care needs are usually bear the full cost of the frames if they are not covered
higher. In practice, many countries have safety-nets in by complementary private insurance. Overall, therapeutic
place to protect vulnerable groups of the population (such goods account for more than 20% of household spending in
as the poor, the elderly, or people with chronic diseases the Netherlands, the United Kingdom, Slovenia, Germany
or disabilities) from excessive out-of-pocket payments. and the Slovak Republic.
These may be partial or total exemptions or a cap on direct Coverage for dental treatment is typically limited and
payments, either in absolute terms or as a share of income as such dental care plays a significant part in outpatient
(Paris et al., 2016). and overall household spending, accounting for 20% of
The burden of out-of-pocket medical spending (that is, all out-of-pocket expenditure across OECD countries. In
excluding long-term care services) can be measured either Spain, Norway and Estonia, this figure reaches 30% or
as a share of total household income or consumption. The more. This can at least partly be explained by the limited
share of household consumption allocated to medical care compulsory coverage for dental care in these countries
varied considerably across OECD countries in 2015, ranging compared with a more comprehensive coverage for other
from lows of around 1.5% of total household consumption categories of care.
in France, luxembourg and the United Kingdom, to more
than 5% in Korea and Switzerland (Figure 5.7). On average,
across OECD countries, 3% of household spending goes on Definition and comparability
medical goods and services.
Health systems in OECD countries differ in the degree of Out-of-pocket payments are expenditures borne
coverage for different health services and goods. In most directly by a patient where neither compulsory nor
countries, a higher proportion of the cost is paid directly voluntary insurance cover the full cost of the health
for pharmaceuticals, dental care and eye care than for good or service. They include cost-sharing and other
hospital care and doctor consultations (Paris et al., 2016). expenditure paid directly by private households and
Taking into account these differences and also the relative should also include estimations of informal payments
importance of these different spending categories, it is not to health care providers. Only expenditure for medical
surprising that there are significant variations between spending (i.e. current health spending less expenditure
OECD countries in the breakdown of the medical costs that for the health part of long-term care) is presented here,
households have to bear themselves. because the capacity of countries to estimate private
In most OECD countries, spending on pharmaceuticals and long-term care expenditure varies widely.
outpatient care (including dental care) are the two main
spending items for out-of-pocket expenditure (Figure 5.8).
These two components typically account for almost four- References
fifths of all medical spending by households. Co-payments
and additional services can result in a larger proportion Paris, V. et al. (2016), “Health Care Coverage in OECD Countries
of the cost of inpatient care being taken on directly by in 2012”, OECD Health Working Papers, No. 88, OECD
households –Greece, Belgium and the Netherlands report a Publishing, Paris, http://dx.doi.org/10.1787/5jlz3kbf7pzv-en.
HEAlTH AT A GlANCE 2017 © OECD 2017
92
5. ACCESS TO CARE
Out-of-pocket medical expenditure
5.7. Out-of-pocket medical spending as a share of final household consumption, 2015 (or nearest year)
%
6
3 1
5. 5.
5 4
4. 4
4. 1
4. 3.9 8 7
4 3. 3. 6
3. 4 3 2
3. 3. 3. 1 1 1 0 0 0
3. 3. 3. 3. 3. 3. 9
3 2. 7 6 6 5 5 5
2. 2. 2. 2. 2. 2. 3
2.4 2.4 2. 2 1
2. 2. 0
2 2. 8
1. 5 4 4
1. 1. 1.
1
0
nd ea ce ry ile ia al in co ael en m lia nd ly nd ria 34 ay ia rk an nd nd es ds lic lic da nd ia ny m rg ce
rla or ee ga Ch atv tug pa xi sr ed giu tra la Ita la st D rw ton ma ap la la tat an ub ub na la en a do ou an
ze K Gr un L or S Me I w el s Ice Fin Au EC o Es en J Po Ire S erl ep ep Ca ea lov erm ng b Fr
it H P S B Au O N D ed th R S G Ki em
Sw nit Ne ak ch R ew Z ed ux
U lov ze N nit L
S C U
Note: This indicator relates to current health spending excluding long-term care (health) expenditure.
Source: OECD Health Statistics 2017.
12 http://dx.doi.org/10.1787/888933603222
5.8. Out-of-pocket medical spending by services and goods, 2015 (or nearest year)
Pharmaceuticals Therapeutic goods¹ Dental
% Outpatient² Inpatient³ Other
100 3 3 7 7 2 1 3 4 1 6 7 1 6 2 5
9 8 16 12 10 9 13 16 9 8 3 10
16 14 16 16 5 15 20
13 14 27 25 28 32 26 23 19
80 3 30 26
30 30 10 28 21 14 30
7 16 21 23 40 27 29 42
6 19 31 42 51 35 55 22
6 8 22 56
60 10 28 29 19 25 18 26 27 31
13 12 12 10 21
20 34 8 19
3 9 8 8 21 20 29
1 10 14 12 11 13 18 11 27 20
40 10 14 15 20
64 1 6 8 17 15
59 7 10
48 48 6 15
20 46 44 43 42 42 42 41
38 37 36 36 36 36 35 33 33 32 31 30
29 28 27 27 27 26 25 25
16
0
co nd da lic ry an lic ia ia m nd lia ce 31 en ia el ce ly nd in ea nd rk m ay ds ny ria al nd rg
xi la na ub ga ap ub atv ton do la tra an D ed en sra ee Ita la pa or la ma giu rw an a st tug rla ou
Me Po Ca ep un J ep L Es ng Ice us Fr EC w lov I Gr Fin S K Ire en el o erl erm Au or ze b
H R Ki A O S S D B N th G P it em
ch R ak ed Ne Sw ux
ze lov nit L
C S U
Note: This indicator relates to current health spending excluding long-term care (health) expenditure.
1. Including eye care products, hearing aids, wheelchairs, etc.
2. Includes home care and ancillary services (and dental if not shown separately).
3. Including day care.
Source: OECD Health Statistics 2017.
12 http://dx.doi.org/10.1787/888933603241
HEAlTH AT A GlANCE 2017 © OECD 2017
93
From:
Health at a Glance 2017
OECD Indicators
Access the complete publication at:
https://doi.org/10.1787/health_glance-2017-en
Please cite this chapter as:
OECD (2017), “Out-of-pocket medical expenditure”, in Health at a Glance 2017: OECD Indicators, OECD
Publishing, Paris.
DOI: https://doi.org/10.1787/health_glance-2017-26-en
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