Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema.
Out-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 p...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0216386 |
| _version_ | 1818682584129863680 |
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| author | Gregoire Mercier Jenica Pastor Valerie Clément Ulysse Rodts Christine Moffat Isabelle Quéré |
| author_facet | Gregoire Mercier Jenica Pastor Valerie Clément Ulysse Rodts Christine Moffat Isabelle Quéré |
| author_sort | Gregoire Mercier |
| collection | DOAJ |
| description | Out-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. We measured the lymphedema-specific outpatient out-of-pocket payments over 6 months. The vertical equity of out-of-pocket payments was examined using concentration curves, the Gini coefficient for income, the Kakwani index, and the Reynolds-Smolensky index. We included 231 lymphedema patients aged 7 years or more, living in metropolitan France, and being able to use Internet and email. After voluntary health insurance reimbursement, the mean out-of-pocket payment was equal to 101.4 Euros per month, mainly due to transport (32%) and medical devices (26%). Concentration curves indicated regressivity of out-of-pocket payments. Total out-of-pocket payments represented 10.1% of the income by consumption unit for the poorest quintile and 3.5% for the wealthiest (p<0.05). The Kakwani index for out-of-pocket payments was equal to -0.18. Regarding outpatient health care, French lymphedema patients face significant and regressive out-of-pocket payments, associated with an increased risk of unmet medical needs. Such results shed light on significant socioeconomic inequalities and bring into question the current financing arrangements of outpatient health care in France. Trial registration: ClinicalTrials.gov ID: NCT02988479. |
| first_indexed | 2024-12-17T10:21:10Z |
| format | Article |
| id | doaj.art-e5d17e7476e342f19dcc2300a743e449 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-17T10:21:10Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-e5d17e7476e342f19dcc2300a743e4492022-12-21T21:52:48ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01145e021638610.1371/journal.pone.0216386Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema.Gregoire MercierJenica PastorValerie ClémentUlysse RodtsChristine MoffatIsabelle QuéréOut-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. We measured the lymphedema-specific outpatient out-of-pocket payments over 6 months. The vertical equity of out-of-pocket payments was examined using concentration curves, the Gini coefficient for income, the Kakwani index, and the Reynolds-Smolensky index. We included 231 lymphedema patients aged 7 years or more, living in metropolitan France, and being able to use Internet and email. After voluntary health insurance reimbursement, the mean out-of-pocket payment was equal to 101.4 Euros per month, mainly due to transport (32%) and medical devices (26%). Concentration curves indicated regressivity of out-of-pocket payments. Total out-of-pocket payments represented 10.1% of the income by consumption unit for the poorest quintile and 3.5% for the wealthiest (p<0.05). The Kakwani index for out-of-pocket payments was equal to -0.18. Regarding outpatient health care, French lymphedema patients face significant and regressive out-of-pocket payments, associated with an increased risk of unmet medical needs. Such results shed light on significant socioeconomic inequalities and bring into question the current financing arrangements of outpatient health care in France. Trial registration: ClinicalTrials.gov ID: NCT02988479.https://doi.org/10.1371/journal.pone.0216386 |
| spellingShingle | Gregoire Mercier Jenica Pastor Valerie Clément Ulysse Rodts Christine Moffat Isabelle Quéré Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema. PLoS ONE |
| title | Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema. |
| title_full | Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema. |
| title_fullStr | Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema. |
| title_full_unstemmed | Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema. |
| title_short | Out-of-pocket payments, vertical equity and unmet medical needs in France: A national multicenter prospective study on lymphedema. |
| title_sort | out of pocket payments vertical equity and unmet medical needs in france a national multicenter prospective study on lymphedema |
| url | https://doi.org/10.1371/journal.pone.0216386 |
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