High Out-Of-Pocket Payments: Beneficiaries' Profiles and Persistence Over Time

Carine Franc
I n s t i t u t d e r e c h e r c h e e t d o c u m e n t a t i o n e n é c o n o m i e d e l a s a n t é 1 The "responsible contract" is a complementary health insurance (CHI) contract that encourages the compliance with the gatekeeping pathway and which legally circumscribes the guarantee levels in order to limit extra fees and optical care reimbursements, while copayments are totally reimbursed. Aurélie Pierre (Irdes) In France, Out-Of-Pocket payments (OOP) to be paid by the insured after
more » ... he insured after reimbursements by the National Health Insurance (NHI) account for a quarter of health spending on average. However, these costs can be very high for some people and constitute a barrier to access to care, especially when they are repeated over time. From the Health, Health Care and Insurance Survey (Enquête santé et protection sociale, ESPS) matched to health-care consumption data, we defi ned profi les of the 10% of individuals who bore the highest burden in OOP in 2010 using a typology. Four profi les are identifi ed based on various care items consumed and then described according to their socioeconomic characteristics and health status. The fi rst profi le gathers patients primarily treated as outpatients for chronic diseases; the second profi le gathers vulnerable individuals hospitalized in a public institution ; the third profi le mainly relates to employees who have spent on dental care; and the fourth profi le gathers non-hospitalized elderly. The results show that individuals belonging to the fi rst profi le were the most likely to incur high OOP two years later (in 2012).