Inequalities in Actual Patient Payments, Willingness and Ability to Pay

Liubovė Murauskienė


In Lithuania, out-of-pocket patient payments (OOP) in health sector have been the focus of political debates for many years. Pharmaceutical costs constitute a major share of private expenditure on health. However, the OOPs for services both official and unofficial (including quasi official) are significant. The aim of the paper is to present the outcomes of the analysis addressed to patient’s characteristics influencing the OOPs for health services and individual willingness to pay (WTP) as well as inequality dimensions of the OOPs in Lithuania. It is the first outcome of the analysis of the data collected in July, 2010, within the international collaborative project “Assessment of patient payment policies and projection of their efficiency, equity and quality effects. The case of Central and Eastern Europe”. The study was financed by the European Commission under FP7 Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (GA no. 217431). The content of the publication is the sole responsibility of the author and it in no way represents the views of the Commission or its services.
The data on the OOPs were collected through a nationally representative survey (N=1012) in July, 2010, using face-to-face interviews based on a standardized questionnaire. The questionnaire was discussed with external experts and pre-tested in a pilot study.
During the period of July, 2009 – June, 2010, patients spent on average 146 litas7 for health services or, recalculated for those, who actually paid for the services (about 37% of adult population), 325 litas. Official average payment for outpatient consultation equals 64.6 litas, unofficial one – 72.8 litas. Despite negligible private provision of inpatient services and the declared “all included” hospital services, official average payment in hospital was about 246 (7–200) litas; unofficial payments for inpatient services were the most frequent within the corresponding patients’ group, when almost a half of the patients paid 158 (0.5–1600) litas per hospitalization.
Males and the poorest population paid for healthcare less frequently in opposite to more frequent payments among those, who were not satisfied with the quality of the services. Moreover, almost 58 percent of the population agreed to pay officially for better quality services in a case of facing serious threat to their health. In less severe cases, the WTP was even higher when 82 percent, and 71 percent of the respondents agreed to pay officially on average 42 litas and 355 litas for outpatient and inpatient services, respectively. The WTP for the outpatient services was the lowest among the poorest and country-side citizens, as well as those, who had a lower education level. At the same time, living in cities, single persons and those, who had not paid for inpatient services, were determinants for reducing the WTP for the inpatient services. Unemployed and single persons with 10 times higher probability would not agree to pay officially for the outpatient services.
About 21.8 percent of the respondents (N=980) said that they needed but could not afford and did not use the outpatient services at least once a year. Regarding the inpatient services, a share of the patients rejecting the services was much less – 3.3 percent.
In 2010, the actual (and in less degree accepted) OOPs in Lithuania were regressive (Kakwani index -0.279 and -0.223 correspondingly).


Out-of-pocket patient payments; willingness-to-pay; ability-to-pay; inequality

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O‘Donnell O., van Doorslaer E., Wagstaff A., Lindelow M. Analysing Health Equity Using Household Survey Data. A Guide to techniques and Their Implementation. 2008. The World Bank. Washington, D.C.

Murauskiene L.,Veniute M., Pavlova M., Groot W. Towards a more comprehensive view on patient payments in Lithuania: new findings from a population survey. Society and Economy. 34 (2012) 2. p. 241-251.


Lietuvos Respublikos Darbo ir socialinės apsaugos ministerija.


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"Health Policy and Management" ISSN online 2029-9001 / ISSN print 2029-3569