Table 1.

Recent Previous Research on Out-of-Pocket Spending

Study	Countries	Data/Variable	Key Findings	Relevance
Baird, 2016 [1]	Australia, France, Israel, Japan, Poland, Russia, Slovenia, Switzerland, United States	Individual survey on OOP spending compared to income from Luxembourg Income Study (2010 for most countries)	• In median country, 13% of people spend more than 10% of income in OOP. • Varies from 3% (France) to 17% (Switzerland). • Poor and elderly at greatest risk of cata-strophic spending.	• Focuses on percentage of population with high OOP spending during a single year. • Emphasizes groups that are most financially vulnerable. • Does not examine countries’ health policies. • Does not examine perceived barriers on access to care.
Palladino et al., 2016 [2]	Austria, Belgium, Czech Republic, Denmark, France, Germany, Netherlands, Spain, Sweden, Switzerland	Survey of people age 50 and older from Health, Ageing and Retirement in Europe, with data on changes in OOP spending and experiencing catastrophic OOP spending (30% or more of income), from 2006/7 to 2013 (Great Recession)	• Very large range in changes in OOP spending (− 11% in Netherlands to + 101% in Austria). • Increase in catastrophic spending: from 2.3 to 3.9% over study period. • People age 50 and older spent more in 8 of11 countries. • Countries do provide financial protection for poor.	• Focuses on changes in OOP spending during limited time period. • Does not examine countries’ health policies. • Does not examine perceived barriers on access to care.
Tambor et al., 2011 [3]	27 countries in the European Union	Review of international data bases, laws and regulations, and reports on changes in patient cost sharing requirements since 1990	• Cost-sharing requirements vary a great deal between countries, and have increased significantly in many. • Tax-based systems more likely to use co-payments, insurance-based systems more likely to use deductibles and coinsurance. • Almost all countries have policies to protect the poorest and/or sickest.	• Focuses on health policies in countries, but little detail provided. • Includes extremely diverse set of countries. • Does not examine perceived barriers on access to care.
Zare & Anderson, 2013 [4]	France, Germany, Japan, United Kingdom, United States (Medicare only)	Various data sets from OECD, WHO, European Observatory, and country-specific reports, time period 2000–2010; separately examine cost sharing for pharmaceuticals, inpatient, and ambulatory care	• Inflation-adjusted OOP spending, and spending divided by income, increased in all countries. • Percent of total national health care paid OOP declined in most countries due to protection mechanisms for poor and/or sick.	• Focuses on health policies in 5 countries. • Does not examine perceived barriers on access to care.