Out-of-pocket expenditure on community healthcare services at end-of-life among decedents from cardiovascular disease in six European countries and Israel

Objectives Most people who develop chronic diseases, including cardiovascular disease (CVD), live in their homes in the community in their last year of life. Since cost-sharing is common in most countries, including those with univer‑ sal health insurance, these people incur out of pocket expenditure (OOPE). The study aims to identify the prevalence and measure the size of OOPE among CVD decedents at end-of-life (EOL) explore diferences among countries in OOPE, and examine whether the decedents' characteristics or their countries' health policy afects OOPE more. Methods SHARE data among people aged 50+from seven European countries (including Israel) who died from CVD are analyzed. Decedents' family members are interviewed to learn about OOPE on their relatives' account. Results We identifed 1,335 individuals who had died from CVD (average age 80.8 years, 54% men). More than half of CVD-decedent people spend OOPE on community services at EOL and their expenditure varies widely among countries. About one-third of people in France and Spain had OOPE, rising to around two-thirds in Israel and Italy and almost all in Greece. The average OOPE is 391.9 PPT, with wide variance across countries. Signifcant odds of OOPE exist in the country variable only, and signifcant diferences exist in the amount of OOPE among countries and dura‑ tion of illness preceding death. Conclusions Since improving CVD care efciency and efectiveness are key aims, healthcare policymakers should broaden the investigation into expanding public funding for community services in order to mitigate OOPE, alle‑ viate the economic burden on households, mitigate forgoing of community services due to price, and reduce rehospitalization.