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Table 2 The description of health policies aiming at OOP burden reduction

From: Does cost sharing do more harm or more good? - a systematic literature review

Jurisdiction Health policy objective in the studied period Cost sharing mechanism Reference
Outpatient/Inpatient services Pharmaceuticals
1 Canada Decrease the OOP burden regarding pharmaceutical spending for least disadvantaged NA Shift from age-based to income-based eligibility drug reimbursement system: 1. before 2002; 100 % drug coverage for social assistance recipients, 100 % coverage with pharmacists’ dispensing fees for seniors and fixed-deductible coverage for ‘catastrophic’ drug expenses for others 2. In 2002; prescription fees for seniors with cap on spending, others remained unchanged 3. from 2003; three age-income groups, co-insurance varies from 0 to 30 %, family deductibles- from 0 to 3 % of household gross income, max OOPs- from 0 to 4 % of household gross income [10]
2 China Decrease the OOP burden after the introduction of insurance based healthcare system. There are two types of healthcare insurance for city dwellers. Urban Resident’s Basic Medical Insurance (UWBMI) for employees and Urban Resident’s Basic Medical Insurance (URBMI) for the unemployed, children, students, and elderly persons without pensions were introduced. In the UWBMI, employees and employers contribute 2 % and 6–8 % of salaries respectively. The URBMI is funded by individuals with appropriate subsidies granted by government. In 2003 New Rural Cooperative Medical Scheme (NCMS) for rural workers were established (92 % coverage in 2007). NA [17, 18]
3 Columbia Decrease the OOP burden after the introduction of insurance based healthcare system. In 1993 National Social Health Insurance System (NSHIS) was established: 1. Employed and self-employed were financed solidarly by employees and employers (in total 12 % of salary). It covered all first-degree family members of those who contribute and pensioners. 2. Poor were financed by taxes and solidarity contribution from other insurance funds. The poor was defined by set of criteria such as labor market participation, income, educational attainment, family structure, access to water and sanitation and others. Interventions are grouped by categories of medical care and levels of complexity. NA [14, 32]
4 Iran Decrease the OOP burden after the introduction of insurance based healthcare system. Healthcare reform steps: 1. development of primary health care (PHC) networks and medical facilities (1990–94), 2. the introduction of health insurance (1994–99), 3. Further development and improvement of healthcare coverage (2000–04), 4. decreasing inequalities in health expenditures (2005–09) NA [19]
5 Thailand The extension of universal healthcare coverage Since October 2001, Universal health insurance system: the curative package (ambulatory and hospitalization service), the high-cost care package, and the promotive and preventive package. The B 30 copayment was introduced in 2001 (equivalent to US$ 1 in 2010) per ambulatory visit or hospital admission. It was abolished in 2006. The total number of insured rose from 33 % in 1991 to 71 % in 2001 and 98 % in 2007. In 2007, the universal coverage was the biggest insurer (75 % of total population), Social Security Scheme for private employees (13 %), Civil servants for public employees (8 %) private health insurance (2 %). In 2003 a universal access to antiretroviral drugs was established. [12]
6 Turkey Extension of free of charge healthcare for low income inhabitants (green card holders) In 1992 a Green card system was established for income below one-third of the base wage rate (ca 18 % of population in 2007). It allowed a free access to inpatient care. In 2004 it was extended to cover alllevels of healthcare except for 20 % co-payment for pharmaceuticals. One year later, Green Card holders were given access to outpatient care and pharmaceuticals. In 2008, they have formally joined Universal Health Insurance. By 2011, about 85 % of the poorest decile was covered by the Green Card or another insurance scheme.
Non-Green card holders pay 8 TL (€3.6) and 15 TL (€6.8) for outpatient services in public and private hospitals, respectively unless they have referral from a GP. Primary care services are free of charge. After 2003, additional copays may apply if the cost of care in a private hospital is higher than public reimbursement. Informal payments are estimated at 5.2 % of total OOP expenditure.
20 % of prescription charges for all active workers including Green Card holders; retirees pay 10 %. Since 2004, 333 jumbo referencing groups established. A reimbursement for any product set at the level of the cheapest in the group plus 15 %. Patient pays the difference between reimbursement and the actual price of the drug. [15, 16, 38, 39]
7 Vietnam The role of Voluntary Health Insurance in broadening the access to healthcare system Since 1991, healthcare services were covered mainly through OOPs. After healthcare reform in 1992, three groups of beneficiers were established: 1.eligible for Compulsory Health Insurance (public sector, workers of private companies companies with over ten employees) 2. eligible for Voluntary Health Insurance (employed not included in 1, self-employed, dependend of those in group 1, school children and other students) 3. Not eligible for Compulsory Health Insurance and too poor for VHI. Out of 76 mln of Vietnamese in the group 2, 3.6 mln had VHI and 33.4 mln still paid fully OOPs. Since 1998, insured patients are obliged to make a copayment of 20 % of the total costs of care provided. An annual ceiling of half the minimum annual salary was introduced as well. NA [13]