The financial burden of out-of-pocket patient payments in the European Union and accession countries: Results of a systematic literature review

A major issue for public health policy is to reduce the poverty and catastrophic effects of out-of-pocket payments. This paper reviews empirical studies that analyze the financial burden of out-of-pocket payments and factors that are associated with this burden for households in the EU and accession countries. The method of systematic literature review is applied. Poverty effects appear to be independent of geographical area. Catastrophic healthcare expenditure ranges from a bit less than 0.05% to nearly 4%, and the impoverishment due to out-of-pocket payments is also up to 4%. Analyses carried out in single countries reveal that living in a household with a pensioner contributes most to high payments for health care. The results support calls for health policy to prevent the burden of out-of-pocket payments, especially for pharmaceutical expenditure. Special attention should be paid to risk groups such as pensioners, female headed households and low income households.