Out-of-pocket payments, vertical equity and unmet medical needs in France: a national multicenter prospective study on lymphedema

Mercier, G, Pastor, J, Clément, V, Rodts, U, Moffatt, C ORCID: https://orcid.org/0000-0002-2436-0129 and Quéré, I, 2019. Out-of-pocket payments, vertical equity and unmet medical needs in France: a national multicenter prospective study on lymphedema. PLoS ONE, 14 (5): e0216386. ISSN 1932-6203

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Abstract

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.

Item Type:	Journal article
Publication Title:	PLoS ONE
Creators:	Mercier, G., Pastor, J., Clément, V., Rodts, U., Moffatt, C. and Quéré, I.
Publisher:	Public Library Of Science
Date:	2019
Volume:	14
Number:	5
ISSN:	1932-6203
Identifiers:	Number Type 10.1371/journal.pone.0216386 DOI
Rights:	Copyright: © 2019 Mercier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Divisions:	Schools > School of Social Sciences
Record created by:	Linda Sullivan
Date Added:	20 May 2019 13:24
Last Modified:	20 May 2019 13:25
URI:	https://irep.ntu.ac.uk/id/eprint/36611

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