By Tim Wrightson, Editor, Applied Health Economics and Health Policy

The latest issue of Applied Health Economics and Health Policy includes three articles that contribute to the literature on the relationship between out-of-pocket (OOP) payments and the accessibility and affordability of healthcare.

Firstly, Erik Schokkaert and colleagues review the relationship between OOP payments and people reporting that they postpone or forgo healthcare in developed countries. Unsurprisingly, the relationship is strongest for people with low incomes and those lacking insurance coverage. The other two articles provide further empirical evidence. The first study surveyed Danish patients about potential user fees for general practitioner (GP) visits and found that half of them would not be willing to pay. Moreover, willingness to pay was lower for patients on lower incomes and those without private health insurance. Patients also indicated a willingness to substitute GP visits with free alternatives. Finally, an Australian study explored the relationship between prescription co-payments and adherence to statins. Again, the effect was most pronounced in low-income patients, who had the lowest adherence when faced with a high co-payment. These articles reemphasise the concern that OOP payments may have negative consequences for the most vulnerable people if they result in the avoidance of necessary treatment. If patients avoid seeking primary care or filling prescriptions due to costs, this may result in worse health outcomes including expensive hospitalisations.

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