The financial burden of out-of-pocket patient payments in the European Union and accession countries: Results of a systematic literature review

A major issue for public health policy is to reduce the poverty and catastrophic effects of out-of-pocket payments. This paper reviews empiricalstudies that analyze the financial burden of out-of-pocket payments and factors that are associated with this burden for households in the EU and accessioncountries. The method of systematic literature review is applied. Poverty effects appear to be independent of geographical area. Catastrophichealthcare expenditure ranges from a bit less than 0.05% to nearly 4%, and the impoverishment due to out-of-pocket payments is also up to 4%.Analyses carried out in single countries reveal that living in a household with a pensioner contributes most to high payments for health care. Theresults support calls for health policy to prevent the burden of out-of-pocket payments, especially for pharmaceutical expenditure. Special attentionshould be paid to risk groups such as pensioners, female headed households and low income households