The incidence of high medical expenses by health status in seven developed countries

Health Policy. 2016 Jan;120(1):26-34. doi: 10.1016/j.healthpol.2015.10.004. Epub 2015 Nov 24.


Health care policy seeks to ensure that citizens are protected from the financial risk associated with needing health care. Yet rising health care costs in many countries are leading to a greater reliance on out-of-pocket (OOP) measures. This paper uses 2010 household survey data from seven countries to measure and compare the burden OOP expenses place on individuals. It compares countries based on the extent to which citizens with health problems devote a large share of their income to OOP expenses. The paper finds that in all countries but France, and to a lesser extent Slovenia, citizens with health problems face considerably higher medical costs than do those without. As many as one-quarter of less healthy citizens in the US, Poland, Russia and Israel devote a large share of their income to OOP expenses. The paper also finds a strong cross-national correlation between the degree to which citizens face high OOP expenses, and the disparities in OOP expenses between those with and without health problems. The levels of high OOP spending uncovered, and their inequitable impact on those with health problems in the seven countries, underscore the potential for OOP measures to undermine core objectives of health care systems, including those of equitable financing, equal access, and improved health among the population.

Keywords: Cost of illness; Cost-sharing; Health insurance; Health policy; Healthcare financing.

MeSH terms

  • Cost of Illness
  • Developed Countries*
  • Financing, Personal* / statistics & numerical data
  • Health Expenditures* / statistics & numerical data
  • Health Policy
  • Health Status*
  • Humans
  • Insurance, Health
  • Surveys and Questionnaires