The out-of-pocket health burden in the Czech Republic - Should we care?

The system of cost sharing has changed several times in the Czech Republic, and it is not out of the question that further changes will take place. High out-of-pocket payments have a considerable impact on patients and the burden on their household budgets. Therefore, we aim to evaluate the impact of out-of-pocket payments on the burden of Czech households from a long term perspective and to determine the most vulnerable groups, taking into account policy changes across the observed period of 2007-2014. We use micro data from the Household Budget Survey conducted by the Czech Statistical Office. The burden and its changes are observed and a burden breakdown for out-of-pocket payment types is made. Special attention is paid to households with members aged 65 or more, and also to households with children. To estimate the burden, regression models are run using the Ordinary Least Square method with robust standard errors. We found that the burden is not equitably distributed among households, but that it tends to decrease with time. Modifications in user fees contributed to this decreasing trend. Even though protective mechanisms from high out-of-pocket payments are applied in the health care system, households with members aged over 65 years faced the highest burden. Another significant predictor of the high burden is household income and the presence of a health problem. Improvement of protection would be justifiable, especially in relation to the income situation of the household.