Changes in equity in out-of-pocket payments during the period of health care reforms: Evidence from Hungary

Petra Baji, Milena Pavlova, L. Gulácsi, Wim Groot

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective: The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods: We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005-2008): before, during and after the implementation of the health care reforms. Results: We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of ?0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6-7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index ?0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78-85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index ?0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from ?0.20/-0.18 to ?0.12.) Conclusions: More attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing.

Original languageEnglish
Article number36
JournalInternational Journal for Equity in Health
Volume11
Issue number1
DOIs
Publication statusPublished - 2012

Fingerprint

Health Care Reform
Hungary
Health Expenditures
Delivery of Health Care
Health Services
Pharmaceutical Preparations
Healthcare Financing
Equipment and Supplies
Pharmaceutical Services
Fees and Charges
Budgets

Keywords

  • Equity
  • Health care reforms
  • Household expenditure
  • Hungary
  • Kakwani index

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Changes in equity in out-of-pocket payments during the period of health care reforms : Evidence from Hungary. / Baji, Petra; Pavlova, Milena; Gulácsi, L.; Groot, Wim.

In: International Journal for Equity in Health, Vol. 11, No. 1, 36, 2012.

Research output: Contribution to journalArticle

@article{76c4b4c60d5040c988714c7113c70d06,
title = "Changes in equity in out-of-pocket payments during the period of health care reforms: Evidence from Hungary",
abstract = "Background: At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective: The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods: We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005-2008): before, during and after the implementation of the health care reforms. Results: We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of ?0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6-7 {\%}) compared to households in the highest income quintile (2 {\%}). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index ?0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78-85 {\%}). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index ?0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from ?0.20/-0.18 to ?0.12.) Conclusions: More attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing.",
keywords = "Equity, Health care reforms, Household expenditure, Hungary, Kakwani index",
author = "Petra Baji and Milena Pavlova and L. Gul{\'a}csi and Wim Groot",
year = "2012",
doi = "10.1186/1475-9276-11-36",
language = "English",
volume = "11",
journal = "International Journal for Equity in Health",
issn = "1475-9276",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Changes in equity in out-of-pocket payments during the period of health care reforms

T2 - Evidence from Hungary

AU - Baji, Petra

AU - Pavlova, Milena

AU - Gulácsi, L.

AU - Groot, Wim

PY - 2012

Y1 - 2012

N2 - Background: At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective: The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods: We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005-2008): before, during and after the implementation of the health care reforms. Results: We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of ?0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6-7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index ?0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78-85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index ?0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from ?0.20/-0.18 to ?0.12.) Conclusions: More attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing.

AB - Background: At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective: The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods: We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005-2008): before, during and after the implementation of the health care reforms. Results: We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of ?0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6-7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index ?0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78-85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index ?0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from ?0.20/-0.18 to ?0.12.) Conclusions: More attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing.

KW - Equity

KW - Health care reforms

KW - Household expenditure

KW - Hungary

KW - Kakwani index

UR - http://www.scopus.com/inward/record.url?scp=84866132964&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866132964&partnerID=8YFLogxK

U2 - 10.1186/1475-9276-11-36

DO - 10.1186/1475-9276-11-36

M3 - Article

C2 - 22828250

AN - SCOPUS:84866132964

VL - 11

JO - International Journal for Equity in Health

JF - International Journal for Equity in Health

SN - 1475-9276

IS - 1

M1 - 36

ER -