In general, reforms can apply some key strategies to abolish user fees or charges in public health facilities and exempt specific community groups such as the poor and the vulnerable, and pregnant women and children from official payments. While there is no remedy, available information suggests that having well-designed policies and strategies can help countries reduce OOP and its adverse effects successfully. There have been health financing policy reforms and measures in several countries recently to deal with the concerns over high OOP payments. According to Adam Wagstaf (2020), OOP expenditures changed significantly within income groups, ranging from $32 in Sweden to $1200 in Switzerland in the high-income groups, and from six dollars in Madagascar to $100 in Cambodia, Haiti, and Nepal in the low-income ones. However, its growth was slower than that of public spending in all income groups. The total OOP spending increased at least twice as much in low- and middle-income countries during 2000–2017 and reached 46% in high-income ones. The more the health sector grew, the less reliant it would be on OOP spending. Unfortunately, such expenses significantly harmed the poor. Also, Patients in developing countries spent half a trillion dollars each year (over $80 per person) out of their own pockets to receive health services. Ī new report by the World Bank Group stated that OOP payments accounted for a non-negligible part of total health care expenditures in Central and Eastern European countries. High OOP medical costs can use up financial savings and damage credits and have a negative impact on the quality of life, medication adherence, and different health outcomes. OOP payments are not an efficient way of financing health care and may negatively affect equity and cause vulnerable groups to experience poverty. The following factors significantly affect OOP health care costs: increased patient cost-sharing, development of high-deductible health care plans, and more use of costly biologic or designer drugs. They do not have access to insurance coverage and other safeguards against OOPs. OOP health expenditures may increase whenever households opt to access and receive health services but are not protected against high payments since medical costs are high. Therefore, OOPs may be explicitly some part of a policy or can occur through market transactions, or both. OOPs, include purely private transactions (payments made by individuals to private doctors and pharmacies), official patient cost-sharing (user fees/copayments) within defined public or private benefit packages, and informal payments (payments beyond the prescriptions entitled as benefits, both in cash and in-kind). Īs defined by the World Health Organization (WHO), OOP expenses are the individuals’ direct payments to healthcare providers at the time of service use. Government expenditures, out-of-pocket payments (OOPs), and sources like voluntary health insurance, employer-provided health programs, and activities by non-governmental organizations are all included in health spending. Nowadays, spending on health is rising, accounting for 10% of global gross domestic product (GDP). Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures. The present review identified some strategies that affect the OOP payments According to the health system functions framework. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. MethodsĪrticles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty.
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