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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
- annual small increase in deductibles
Employer plans:
- co-insurance, co-payments relatively stable
- 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]