This document discusses patient payment policies in Europe. It summarizes that while most European countries have formal cost-sharing arrangements like co-payments and deductibles, informal payments also exist. Formal and informal payments seem to operate independently. Patient cost-sharing policies aim to improve efficiency, contain costs, and generate revenue for healthcare. While arrangements vary across countries, the most common types are co-payments for visits to general practitioners and coinsurance for hospitals. Exemptions from cost-sharing are common for low-income, children, and elderly patients.

1. Patient payments in Europe Wim Groot Maastricht University National University of Kyiv - Mohyla Academy Kyiv, March 3, 2011

2. Assessment of patient payment policies and projection of their efficiency, equity and quality effects: The case of Central and Eastern Europe ASSPRO CEE 2007 http://assprocee2007.com

3. Consortium Hungary CPASF Center for Public Affairs Studies Foundation 7 Poland UJ CM Uniwersytet Jagiellonski Collegium Medicum 6 Ukraine SOZ Shkola Ohorony Zdorovia 5 Romania SNSPMS Scoala Nationala de Sanatate Publica si Management Sanitar 4 Lithuania MTVC Public Enterprise “MTVC” 3 Bulgaria MU-Varna Medical University of Varna 2 The Netherlands UM Universiteit Maastricht (coordinator) 1 Country Short name Beneficiary name Number

7. Formal-informal patient payments mix in Europe

9. Source: Stepurko et al.: Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments . BMC Health Services Research 2010, 10:273.

12. Basic characteristics of the EU health care systems (2007-2008) Source: Tambor, M., Pavlova, M., Woch, P. & Groot, W. (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. European Journal of Public Health . Forthcoming.

13. Source: OECD Health Data 2006 31.9 31.6 31.5 31.7 32.9 Switzerland 13.2 13.5 13.7 14.2 14.9 United States 10.4 10.0 9.7 10.1 9.5 Tsjech rep. 23.6 24.1 23.7 23.9 23.6 Spain 21.6 21.2 22.3 23.2 22.2 Portugal 28.1 26.4 25.4 28.1 30.0 Poland 14.7 15.0 15.0 15.7 16.7 Austria 15.7 15.5 15.8 15.7 16.7 Norway 7.8 7.9 8.0 8.7 9.0 Netherlands 6.7 6.7 6.9 6.5 7.0 Luxemburg 17.3 17.3 16.5 16.9 Japan 19.6 20.7 20.4 20.3 22.8 Italy 45.2 43.7 43.3 42.4 44.9 Greece 7.6 7.7 7.9 10.4 10.5 France 10.4 10.3 10.7 10.6 Germany 13.9 13.9 15.8 15.9 16.0 Denmark 14.9 14.5 15.2 15.2 15.9 Canada 2004 2003 2002 2001 2000 Co-payments as percentage of total health care expenditures, 2000-2004

15. Patient cost-sharing arrangements in the EU for three types of services (2007-2008) Source: Tambor, M., Pavlova, M., Woch, P. & Groot, W. (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. European Journal of Public Health . Forthcoming.

19. The dynamics of patient cost-sharing in the EU Source: Tambor, M., Pavlova, M., Woch, P. & Groot, W. (2010). Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. European Journal of Public Health . Forthcoming.

23. Wim Groot Professor of Health Economics Thank you for your attention