title: Out-of-pocket payments in the Austrian healthcare system - a distributional analysis.
abstract: BACKGROUND
  Out-of-pocket spending is an important source of healthcare financing even in countries with established prepaid financing of healthcare. However, out-of-pocket payments (OOPP) may have undesirable effects from an equity perspective. In this study, we analyse the distributive effects of OOPP in Austria based on cross-sectional information from the Austrian Household Budget Survey 2009/10.
  
  
  METHODS
  We combine evidence from disaggregated measures (concentration curve and Lorenz curve) and summary indices (Gini coefficient, Kakwani index, and Reynolds-Smolensky index) to demonstrate the distributive effects of total OOPP and their subcomponents. Thereby, we use different specifications of household ability to pay. We follow the Aronson-Johnson-Lampert approach and split the distributive effect into its three components: progressivity, horizontal equity, and reranking.
  
  
  RESULTS
  OOPP in Austria have regressive effects on income distribution. These regressive effects are especially pronounced for the OOPP category prescription fees and over-the-counter pharmaceuticals. Disaggregated evidence shows that the effects differ between income groups. The decomposition analysis reveals a high degree of reranking and horizontal inequity for total OOPP, and particularly, for therapeutic aids and physician services.
  
  
  CONCLUSIONS
  The results - especially those for prescription fees and therapeutic aids - are of high relevance for the recent and on-going discussion on the reform of benefit catalogues and cost-sharing schemes in the public health insurance system in Austria.
authors.affiliation: Department of Economics and Statistics, University of Innsbruck, Universitaetsstrasse 15, A-6020, Innsbruck, Austria. Alice.Sanwald@uibk.ac.at.
authors.forename: Alice
authors.initials: A
authors.lastname: Sanwald
authors.affiliation: Department of Economics and Statistics, University of Innsbruck, Universitaetsstrasse 15, A-6020, Innsbruck, Austria. Engelbert.Theurl@uibk.ac.at.
authors.forename: Engelbert
authors.initials: E
authors.lastname: Theurl
mesh_terms: D001317:Austria; D003695:Delivery of Health Care; D005382:Financing, Personal / Q000191:economics*; D061889:Healthcare Financing; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research