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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]