title: Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review.
abstract: BACKGROUND
  In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+.
  
  
  METHODS
  Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed.
  
  
  RESULTS
  Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care.
  
  
  CONCLUSIONS
  While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous.
authors.affiliation: University of Leipzig, Health Economics Research Unit, Department of Psychiatry, Liebigstr, 26, 04103 Leipzig, Germany. Sandro.Corrieri@medizin.uni-leipzig.de.
authors.forename: Sandro
authors.initials: S
authors.lastname: Corrieri
authors.forename: Dirk
authors.initials: D
authors.lastname: Heider
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehnert
authors.forename: Elke
authors.initials: E
authors.lastname: Raum
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König