Title: Equity and access to care: the role of out-of-pocket spending in OECD countries

Authors: Lynn A. Blewett; Jiani Yu; Megan Lahr

Addresses: School of Public Health, University of Minnesota, 2221 University Avenue, Suite 345, Minneapolis, MN 55414, USA ' Population Health Sciences, Weill Cornell Medical College, 402 E. 67th Street, New York, New York 10065, USA ' Rural Health Research Center, School of Public Health, University of Minnesota, 2221 University Avenue, Suite 350, Minneapolis, MN 55414, USA

Abstract: Rising medical out-of-pocket (OOP) spending burdens has increased concerns of equity and fairness in healthcare systems. Limited empirical evidence exists examining the impact of OOP spending on barriers to needed care and the increasing role of private supplemental health insurance. Our study uses pooled panel data on country healthcare expenditures from the Organization for Economic Co-operation and Development (OECD) to assess associations between OOP spending growth and measures of healthcare utilisation. Using both fixed effects and random effects regression models, we found a significant increase of 24.8% in OOP spending as a proportion of household income from 2000-2014. OOP spending was negatively associated with breast cancer screening (p < 0.05) and the percentage of individuals over age 65 immunised against influenza (p < 0.05). As countries continue to pursue healthcare system reforms, policymakers must pay close attention to impacts of OOP spending on goals of equity and cost containment.

Keywords: health equity; health systems financing; OECD.

DOI: 10.1504/IJEH.2025.147371

International Journal of Electronic Healthcare, 2025 Vol.14 No.2, pp.176 - 188

Accepted: 05 Aug 2020
Published online: 15 Jul 2025 *

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