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Table 4 Changes in Out-of-Pocket Payment Requirements Over 10-Year Period, by Country. This annex contains a table with a full description of the changes in out-of-pocket requirements over a 10-year period in the ten high-income countries studied in this paper

From: Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries

  Depth Scope Breadth
  Deductibles Co-insurance and co-payments Extra-billing and reference prices Protection mechanisms   
Australia -no change 2005: pharmaceutical co-payments increased to AUD28.60 2015, 2016: increase in pharmaceutical co-payments - annual changes related to decisions of physicians - 2005: incentive payment to GPs who do not extra bill - annual increase in co-insurance caps - 2016: introduction of cap on OOP for extra billing - minimal changes - no change
Canada - no change - provincial level changes for prescriptions - no change - provincial level changes for low-income and elderly caps/exemptions - no federal level change but provincial level changes - no change
England - no change prescriptions: - annual increase of co-payments by GBP0.10–0.20 dental care: - 2006: reduction of co-payments (maximum reduced from GBP384 to 189) - since then regular increase - no change - regular increase of prescriptions cap - no change - no change
France - no change 2005: introduction of €1 co-payments for physician visits, lab tests, x-rays 2006: introduction of €18 co-payment for expensive care (>€120) 2008: introduction of €0.5 co-payment for prescriptions 2013: increase of daily co-payment for hospital care from €16 to €18 - changes related to choices of physicians 2005 and 2008: introduction of €50 caps on co-payments for each type of service - minimal changes - no change; continuous growth of complementary VHI coverage
Germany - no change 2013: €10 per physician visit discontinued 2005: introduction of reference price system for crowns and dentures - no change - minimal changes since 2007: mandatory insurance
Netherlands 2008: €150 deductible introduced 2009–2016: annual increase up to €385 since 2010: emergence of co-insurance for non-contracted providers - no change 2014: several compensations for chronically ill were abolished (e.g. partial compensation for the mandatory deductible), but municipalities may provide such compensations now. Many exclusions and some inclusions, e.g.: 2006: exclusion of adult dental care 2007: inclusion of psychotherapy (severe cases), first IVF (of max. 3) 2009: exclusion of benzos, statins 2009 exclusion of walkers 2011: exclusion of dental care for 18–22 y/o 2011/12: reductions in physical therapy 2012: exclusion of gastric acid blockers 2013: exclusion of simple walking aids 2013–14: inclusion of quit smoking and dietary advice - no change
Norway - no change - small changes to co-payment amounts, slowly increasing - no change - annual revision of co-payment cap, slowly increasing - minimal changes - no change
Sweden - no change - small increases to co-payment amounts for outpatient specialist care without referral in several county councils - no change 2008: reduced co-insurance for dental care above high cost threshold 2012: OOP caps increase: - prescriptions: from SEK 1800 to 2200 - outpatient primary and specialist care: from SEK 900 to 1100 2016: introduction of general exemption from co-payments for prescription drugs for children under 18 2009: prescription drug coverage restricted to lowest cost generic 2013: minor increase in scope of subsidies in dental care to elderly - no change
Switzerland - 2005: max deductible is increased from CHF1500 to CHF2500 - Proportion of insured opting for deductible of CHF2500 increased from around 5% in 2005 to 19% in 2014 2011: hospital co-payment is increased from CHF10 to: CHF 15 / day; 2006: Co-insurance is increased to 20% for brand drugs if a cheaper generic is available; -no change - no change 2011: vision aids excluded from coverage; 2012: alternative and complementary medicine included in benefits catalogue - no change
US Employer plans: - average deductible increase from US$602 in 2005 to US$1318 in 2015 Medicare: - annual small increase in deductibles Employer plans: - co-insurance, co-payments relatively stable Medicare: - annual small increase in co-payments - no change Employer plans: - annual 6% increase of proportion of insured with cost-sharing cap of ≥US$3000 (33% in 2005, 59%) - dental care and vision care excluded in increasing proportion of plans - coverage among the adult population increased from 82.9% in 2013 to 89% in 2016 [19]