What Interventions Work to Reduce Cost Barriers to Primary Healthcare in High-Income Countries? A Systematic Review

Bailey Yee, Nisa Mohan, Fiona McKenzie and Mona Jeffreys ()
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Bailey Yee: Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka–Victoria University of Wellington, Wellington 6011, New Zealand
Nisa Mohan: Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka–Victoria University of Wellington, Wellington 6011, New Zealand
Fiona McKenzie: Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka–Victoria University of Wellington, Wellington 6011, New Zealand
Mona Jeffreys: Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka–Victoria University of Wellington, Wellington 6011, New Zealand

IJERPH, 2024, vol. 21, issue 8, 1-28

Abstract: High-income countries like Aotearoa New Zealand are grappling with inequitable access to healthcare services. Out-of-pocket payments can lead to the reduced use of appropriate healthcare services, poorer health outcomes, and catastrophic health expenses. To advance our knowledge, this systematic review asks, “What interventions aim to reduce cost barriers for health users when accessing primary healthcare in high-income countries?” The search strategy comprised three bibliographic databases (Dimensions, Embase, and Medline Web of Science). Two authors selected studies for inclusion; discrepancies were resolved by a third reviewer. All articles published in English from 2000 to May 2022 and that reported on outcomes of interventions that aimed to reduce cost barriers for health users to access primary healthcare in high-income countries were eligible for inclusion. Two blinded authors independently assessed article quality using the Critical Appraisal Skills Program. Relevant data were extracted and analyzed in a narrative synthesis. Forty-three publications involving 18,861,890 participants and 6831 practices (or physicians) met the inclusion criteria. Interventions reported in the literature included removing out-of-pocket costs, implementing nonprofit organizations and community programs, additional workforce, and alternative payment methods. Interventions that involved eliminating or reducing out-of-pocket costs substantially increased healthcare utilization. Where reported, initiatives generally found financial savings at the system level. Health system initiatives generally, but not consistently, were associated with improved access to healthcare services.

Keywords: cost barriers; health expenditures; health services accessibility; primary healthcare (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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