The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review

Title The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review
Year 2013
Author R. Rezayatmand, M. Pavlova and W. Groot
DOI 10.1093/eurpub/cks034
Journal The European Journal of Public Health
Document Type Journal Article
Document Availability Full Text
Classification Other complementary UHC initiatives
Abstract Reza Rezayatmand1,2, Milena Pavlova1 and Wim Groot1,31 Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands2 Isfahan University of Medical Sciences, Isfahan, Iran3 Top Institute for Evidence-Based Education Research (TIER), Maastricht University, The NetherlandsCorrespondence: Reza Rezayatmand, Department of Health Services Research, P.O. Box 616, 6200MD Maastricht, The Netherlands, tel: +31 43 3881723, fax: +31 43 3884162, e-mail: mr.rezayatmand{at}maastrichtuniversity.nlAbstract Background: Out-of-pocket payments can have a large impact on the demand for healthcare. They can be essential not only to decrease unnecessary service use, but also to encourage the use of particular preventive services provided free of charge or at a lower price. Moreover, out-of-pocket payments may increase the costs of unhealthy behaviour and provide incentives for a healthier lifestyle. Method: This study systematically reviews empirical evidence on the effects of out-of-pocket payments on the use of preventive services and health-related lifestyle. All possible combinations of three key words ‘prevention’, ‘patient payment’ and ‘health-related behaviour’ were searched in PUBMED, ECONLITH, ECONPAPER and EMBASE. In total, 47 relevant publications were identified. Results: The results suggest that out-of-pocket payments can create a financial barrier and can decrease the use of preventive services and the uptake of preventive medications. A few studies (with contradicting empirical evidence) address the impact of cost sharing and reduced insurance coverage on a healthier lifestyle. Conclusion: Although the great diversity of study designs (various indicators of out-of-pocket payments and preventive/health-related behaviour) makes it difficult to offer robust policy recommendations, our findings support calls to reconsider how preventive services should be financed. More research is needed to explore the actual impact of cost sharing on different aspects of health-related lifestyles, as well as to explain the role of other relevant determinants that could impact this relationship.© The Author 2012. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


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