title: The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these?
abstract: Cost-sharing for health care is high on the policy agenda in many European countries that struggle with deficits in their public budget. However, such policy often meets with public opposition, which might delay or even prevent its implementation. Increased reliance on patient payments may also have adverse equity effects, especially in countries where informal patient payments are widespread. The factors which might influence the presence of both, formal and informal payments can be found in economic, governance and cultural differences between countries. The aim of this paper is to review the formal-informal payment mix in Europe and to outline factors associated with this mix. We use quantitative analyses of macro-data for 35 European countries and a qualitative description of selected country experiences. The results suggest that the presence of obligatory cost-sharing for health care services is associated with governance factors, while informal patient payments are a multi-cause phenomenon. A consensus-based policy, supported by evidence and stakeholders' engagement, might contribute to a more sustainable patient payment policy. In some European countries, the implementation of cost-sharing requires policy actions to reduce other patient payment obligations, including measures to eliminate informal payments.
authors.affiliation: Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Poland; Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. Electronic address: marzenawozniak8@wp.pl.
authors.forename: Marzena
authors.initials: M
authors.lastname: Tambor
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.forename: Stanisława
authors.initials: S
authors.lastname: Golinowska
authors.forename: Christoph
authors.initials: C
authors.lastname: Sowada
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D017047:Cost Sharing / Q000191:economics; D003469:Culture; D005060:Europe; D005382:Financing, Personal / Q000458:organization & administration*; D005102:Health Expenditures; D006291:Health Policy
keywords: Cost sharing; Europe; Formal patient charges; Informal patient payments; Out of pocket; Policy implementation