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Organised by: EUPHA (HSR), Observatory Contact: j.dejong@nivel.nl Over the past decades, health care expenditures increased in most OECD countries and are expected to increase even more. A wide ranges of policies are implemented to try to limit this development. Several governments (e.g. of Denmark, Estonia, France, Greece, Ireland, Romania, Russian Federation, Switzerland, and Turkey) increased or introduced patient cost-sharing. Patient cost-sharing can take several direct and indirect forms such as out-of-pocket costs and coverage exclusions, ranging from full third-party payment (zero costsharing) to full user charges (costs met completely by out-ofpocket payments). Macro effects of cost sharing on health care expenditures generally prove to be limited. Nevertheless, there are indications that patient cost-sharing may lead to inequalities in health status between groups and may have unintended effects on the process and outcomes of therapy. This workshop is aimed at giving an overview of the current state of out-of-pocket costs in Europe. In particular, the workshop will go through: a) out-of-pocket costs in different European countries; b) Case study: potential effects of OOP on compliance to specialty referrals in The Netherlands. The workshop will end with a general discussion on cost sharing.

7.F. Workshop: Out-of-pocket costs in Europe and their effects on health-care use