Mapping the Out-of-Pocket Healthcare Costs for Terminal Cancer Patients across Europe

Abstract Background In many countries, including those with universal health insurance, cost-sharing for healthcare is prevalent, resulting in out-of-pocket expenses for cancer patients. However, the proportion of government contribution to national healthcare expenditure varies across countries. This study aims to determine the prevalence and magnitude of out-of-pocket expenditure among cancer decedents in their final year of life and to assess whether decedents’ characteristics or their country’s welfare regime have a greater impact on out-of-pocket expenditure. Methods SHARE data was analyzed for individuals aged 50 and above from seven European countries (including Israel) who passed away from cancer. Interviews were conducted with the decedents’ family members to gather information about out-of-pocket expenditure on behalf of their deceased relatives. Results The study identified 1,950 cancer decedents with an average age of 74.4 (S.D.=9.39), of which 58.0 percent were male. In their last year of life, 58 percent of the decedents incurred out-of-pocket expenditure on healthcare services. The welfare regime is found to be the primary factor influencing the likelihood of out-of-pocket expenditure, while patients’ characteristics have minimal impact. The proportion of out-of-pocket expenditure varies significantly across welfare regimes, with the highest probability observed in the Continental and Social Democratic regimes and the lowest in the Mediterranean and East European regimes. Conclusions A country’s welfare regime plays a crucial role in determining the generosity of its public healthcare spending and its ability to alleviate the financial burden on the households of cancer patients. Increasing public funding for cancer care may reduce patients’ out-of-pocket expenditure in all countries, particularly in those where out-of-pocket expenditure is the highest. Key messages • A country’s welfare regime significantly impacts the likelihood and magnitude of out-of-pocket healthcare expenditure for cancer patients in their last year of life. • Increasing public funding for cancer care may help reduce the financial burden on patients and their families, particularly in countries with high out-of-pocket expenditure.