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BioMed Research International
Volume 2017 (2017), Article ID 2615105, 13 pages
Research Article

Patient Payment and Unhealthy Behavior: A Comparison across European Countries

1Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, Netherlands
3Top Institute for Evidence-Based Education Research (TIER), Maastricht University, Maastricht, Netherlands

Correspondence should be addressed to Reza Rezayatmand

Received 15 June 2016; Revised 29 November 2016; Accepted 13 December 2016; Published 5 February 2017

Academic Editor: Nikolaos Siafakas

Copyright © 2017 Reza Rezayatmand et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Prior research has documented that unhealthy behaviors result in greater health care use and greater health care costs. However, there are few studies on out-of-pocket expenditure paid by those engaging in unhealthy behaviors. We provide cross-country evidence on the association of smoking, alcohol consumption, and obesity with health care use and health care cost as well as out-of-pocket payments among the elderly in Europe. Method. Using SHARE dataset for 13 European countries, the study uses a sequential logit model to analyze use and payments for outpatient and inpatient health care service in addition to a two-part model for the analysis of use and payments for prescribed drugs. Results. Former smoking is associated with a higher rate of health care use. However, current smoking is associated with lower health care use. Former smoking is also associated with paying higher amount of out-of-pocket payments. Alcohol consumption is associated with lower health care use. Conclusion. We do not find systematic evidence that unhealthy behaviors among elderly (50+) are associated with more utilization of health care and more out-of-pocket payments. The results can be of interest for policies that aim to make people more responsible toward their health behaviors.