Table 4.

Changes in Out-of-Pocket Payment Requirements Over 10-Year Period, by Country. This annex contains a table with a full description of the changes in out-of-pocket requirements over a 10-year period in the ten high-income countries studied in this paper

	Depth				Scope	Breadth
	Deductibles	Co-insurance and co-payments	Extra-billing and reference prices	Protection mechanisms
Australia	-no change	2005: pharmaceutical co-payments increased to AUD28.60 2015, 2016: increase in pharmaceutical co-payments	- annual changes related to decisions of physicians	- 2005: incentive payment to GPs who do not extra bill - annual increase in co-insurance caps - 2016: introduction of cap on OOP for extra billing	- minimal changes	- no change
Canada	- no change	- provincial level changes for prescriptions	- no change	- provincial level changes for low-income and elderly caps/exemptions	- no federal level change but provincial level changes	- no change
England	- no change	prescriptions: - annual increase of co-payments by GBP0.10–0.20 dental care: - 2006: reduction of co-payments (maximum reduced from GBP384 to 189) - since then regular increase	- no change	- regular increase of prescriptions cap	- no change	- no change
France	- no change	2005: introduction of €1 co-payments for physician visits, lab tests, x-rays 2006: introduction of €18 co-payment for expensive care (>€120) 2008: introduction of €0.5 co-payment for prescriptions 2013: increase of daily co-payment for hospital care from €16 to €18	- changes related to choices of physicians	2005 and 2008: introduction of €50 caps on co-payments for each type of service	- minimal changes	- no change; continuous growth of complementary VHI coverage
Germany	- no change	2013: €10 per physician visit discontinued	2005: introduction of reference price system for crowns and dentures	- no change	- minimal changes	since 2007: mandatory insurance
Netherlands	2008: €150 deductible introduced 2009–2016: annual increase up to €385	since 2010: emergence of co-insurance for non-contracted providers	- no change	2014: several compensations for chronically ill were abolished (e.g. partial compensation for the mandatory deductible), but municipalities may provide such compensations now.	Many exclusions and some inclusions, e.g.: 2006: exclusion of adult dental care 2007: inclusion of psychotherapy (severe cases), first IVF (of max. 3) 2009: exclusion of benzos, statins 2009 exclusion of walkers 2011: exclusion of dental care for 18–22 y/o 2011/12: reductions in physical therapy 2012: exclusion of gastric acid blockers 2013: exclusion of simple walking aids 2013–14: inclusion of quit smoking and dietary advice	- no change
Norway	- no change	- small changes to co-payment amounts, slowly increasing	- no change	- annual revision of co-payment cap, slowly increasing	- minimal changes	- no change
Sweden	- no change	- small increases to co-payment amounts for outpatient specialist care without referral in several county councils	- no change	2008: reduced co-insurance for dental care above high cost threshold 2012: OOP caps increase: - prescriptions: from SEK 1800 to 2200 - outpatient primary and specialist care: from SEK 900 to 1100 2016: introduction of general exemption from co-payments for prescription drugs for children under 18	2009: prescription drug coverage restricted to lowest cost generic 2013: minor increase in scope of subsidies in dental care to elderly	- no change
Switzerland	- 2005: max deductible is increased from CHF1500 to CHF2500 - Proportion of insured opting for deductible of CHF2500 increased from around 5% in 2005 to 19% in 2014	2011: hospital co-payment is increased from CHF10 to: CHF 15 / day; 2006: Co-insurance is increased to 20% for brand drugs if a cheaper generic is available;	-no change	- no change	2011: vision aids excluded from coverage; 2012: alternative and complementary medicine included in benefits catalogue	- no change
US	Employer plans: - average deductible increase from US$602 in 2005 to US$1318 in 2015 Medicare: - annual small increase in deductibles	Employer plans: - co-insurance, co-payments relatively stable Medicare: - annual small increase in co-payments	- no change	Employer plans: - annual 6% increase of proportion of insured with cost-sharing cap of ≥US$3000 (33% in 2005, 59%)	- dental care and vision care excluded in increasing proportion of plans	- coverage among the adult population increased from 82.9% in 2013 to 89% in 2016 [19]