title: Patient Payment and Unhealthy Behavior: A Comparison across European Countries.
abstract: Introduction. Prior research has documented that unhealthy behaviors result in greater health care use and greater health care costs. However, there are few studies on out-of-pocket expenditure paid by those engaging in unhealthy behaviors. We provide cross-country evidence on the association of smoking, alcohol consumption, and obesity with health care use and health care cost as well as out-of-pocket payments among the elderly in Europe.Method. Using SHARE dataset for 13 European countries, the study uses a sequential logit model to analyze use and payments for outpatient and inpatient health care service in addition to a two-part model for the analysis of use and payments for prescribed drugs.Results. Former smoking is associated with a higher rate of health care use. However, current smoking is associated with lower health care use. Former smoking is also associated with paying higher amount of out-of-pocket payments. Alcohol consumption is associated with lower health care use.Conclusion. We do not find systematic evidence that unhealthy behaviors among elderly (50+) are associated with more utilization of health care and more out-of-pocket payments. The results can be of interest for policies that aim to make people more responsible toward their health behaviors.
authors.affiliation: Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, Netherlands.
authors.forename: Reza
authors.identifier: 0000-0002-9907-3597
authors.initials: R
authors.lastname: Rezayatmand
authors.affiliation: Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Top Institute for Evidence-Based Education Research (TIER), Maastricht University, Maastricht, Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D015992:Body Mass Index; D003625:Data Collection; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010045:Outpatients; D012306:Risk; D012907:Smoking; D011795:Surveys and Questionnaires