title: Diversity and dynamics of patient cost-sharing for physicians' and hospital services in the 27 European Union countries.
abstract: BACKGROUND
  During the past decades, many governments have introduced patient cost-sharing in their public health-care system. This trend in health-care reforms affected the European Union (EU) member states as well. This article presents a review of patient cost-sharing for health-care services in the 27 EU countries, and discusses directions for their improvement.
  
  
  METHODS
  Data are collected based on a review of international data bases, national laws and regulations, as well as scientific and policy reports. The analysis presents a combination of qualitative and quantitative research techniques.
  
  
  RESULTS
  Patient cost-sharing arrangements in the EU have been changing considerably over the past two decades (mostly being extended) and are quite diverse at present. There is a relation between patient cost-sharing arrangements and some characteristics of the health-care system in a country. In a few EU countries, a mix of formal and informal charges exists, which creates a double financial burden for health-care consumers.
  
  
  CONCLUSIONS
  The adequacy of patient cost-sharing arrangements in EU countries needs to be reconsidered. Most importantly, it is essential to deal with informal patient payments (where applicable) and to assure adequate exemption mechanisms to diminish the adverse equity effects of patient cost-sharing. A close communication with the public is needed to clarify the objectives and content of a patient payment policy in a country.
authors.affiliation: Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Kraków, Poland. marzenawozniak8@wp.pl
authors.forename: Marzena
authors.initials: M
authors.lastname: Tambor
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.forename: Piotr
authors.initials: P
authors.lastname: Woch
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D017047:Cost Sharing / Q000639:trends*; D003695:Delivery of Health Care / Q000191:economics*; D004469:Economics, Hospital; D005062:European Union; D005249:Fees and Charges; D006302:Health Services Research; D006801:Humans; D010820:Physicians / Q000191:economics*