Can European Countries Improve Sustainability of Health Care Financing through Patient Cost-Sharing?

Rising health care cost and resource constraints confront policy makers with the challenge to ensure financial sustainability of health care systems, without jeopardizing the main health system . To respond to this challenge, many European countries have introduced patient payments publicly financed health care services (patient cost-sharing) (1-4). The potential of patient costsharing to contribute to the sustainability of the health care system relies on two elements. First, -sharing generates additional sources of funding. Hence, through cost-sharing, some of the care cost might be shifted from public budgets to patients. Second, cost-sharing has the to improve efficiency in publicly financed health care, as it is expected that patients, when with the price of health care services, reduce the utilization of unnecessary and low-value health (5, 6). It is also expected that this could slow the growth of health care costs. However, opponents cost-sharing question the potential of cost-sharing to improve efficiency and instead point to its negative effects on equity in health care. This is documented by evidence, among them best known is the RAND health insurance experiment (7, 8). the potential of cost-sharing can be realized without threatening equity and consumers protection depends on various context-specific factors as well as on the design of the -sharing systems applied by European countries.