{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:11:40Z","timestamp":1789143100395,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Health systems face financial pressures as populations age and economic growth slows, with implications for who pays for health care and for what drives expenditure growth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We examined changes in outpatient and pharmaceutical care financing across OECD countries from 2000 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While overall health spending growth slowed across countries after the Great Recession, household spending grew modestly everywhere, averaging about half a percentage point growth annually. The United States stood out for persistently high out-of-pocket financing burden\u2014over twice that of most peer countries\u2014and for price growth, rather than utilization, driving out-of-pocket spending for pharmaceutical care. Other countries saw out-of-pocket spending driven more by volume growth and slower price growth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These patterns highlight potential affordability pressures from out-of-pocket healthcare payments, particularly in the US Policymakers should regularly monitor financial hardship from out-of-pocket payments and reconsider using cost-sharing to address health financing sustainability challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag234","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:31:43Z","timestamp":1788442303000},"source":"Crossref","is-referenced-by-count":0,"title":["Cross-country differences in household healthcare spending"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8000-3185","authenticated-orcid":false,"given":"Irene","family":"Papanicolas","sequence":"first","affiliation":[{"name":"Professor of Health Services, Policy and Practice, Brown University School of Public Health , 121 S. Main St., Box G-S121-8, Providence, RI 02912 ,","place":["United States"]},{"name":"Department of Health Policy, London School of Economics , London WC2A 2AE ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8269-1578","authenticated-orcid":false,"given":"Jonathan","family":"Cylus","sequence":"additional","affiliation":[{"name":"Professor of Health Services, Policy and Practice, Brown University School of Public Health , 121 S. Main St., Box G-S121-8, Providence, RI 02912 ,","place":["United States"]},{"name":"Department of Health Policy, London School of Economics , London WC2A 2AE ,","place":["United Kingdom"]},{"name":"European Observatory for Health Systems and Policies , London WC2A 2AE ,","place":["United Kingdom"]},{"name":"World Health Organization Barcelona Office for Health Systems Financing , Barcelona 08025 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6245-9856","authenticated-orcid":false,"given":"Maecey","family":"Niksch","sequence":"additional","affiliation":[{"name":"Professor of Health Services, Policy and Practice, Brown University School of Public Health , 121 S. Main St., Box G-S121-8, Providence, RI 02912 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Lorenzoni","sequence":"additional","affiliation":[{"name":"Organization of Economic Cooperation and Development , Paris 75016 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026091111370159100_qxag234-B1","author":"OECD [Internet]","year":"2024"},{"key":"2026091111370159100_qxag234-B2","author":"OECD [Internet]","year":"2024"},{"key":"2026091111370159100_qxag234-B3","author":"Thomson"},{"key":"2026091111370159100_qxag234-B4","author":"World Health Organization Regional Office for Europe"},{"key":"2026091111370159100_qxag234-B5","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14295","article-title":"Cross-country comparisons in health price growth over time","volume":"59","author":"Papanicolas","year":"2024","journal-title":"Health Serv Res"},{"key":"2026091111370159100_qxag234-B6","author":"OECD"},{"key":"2026091111370159100_qxag234-B7","author":"OECD","year":"2026"},{"issue":"1","key":"2026091111370159100_qxag234-B8","doi-asserted-by":"publisher","first-page":"49","DOI":"10.5617\/njhe.5461","article-title":"Evidence and projections on the progressivity of health care financing in Finland","volume":"6","author":"Klavus","year":"2018","journal-title":"Nord J Health Econ"},{"key":"2026091111370159100_qxag234-B9","author":"OBS [Internet]"},{"key":"2026091111370159100_qxag234-B10","author":"OBS [Internet]"},{"key":"2026091111370159100_qxag234-B11","author":"The Health Foundation [Internet]"},{"key":"2026091111370159100_qxag234-B12","author":"Nuffield Trust [Internet]"},{"issue":"20","key":"2026091111370159100_qxag234-B13","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1056\/NEJMsa2414435","article-title":"Loss of subsidized drug coverage and mortality among low-income Medicare beneficiaries","volume":"392","author":"Roberts","year":"2025","journal-title":"N Engl J Med"},{"issue":"1","key":"2026091111370159100_qxag234-B14","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1377\/hlthaff.26.1.154","article-title":"Health care spending growth: how different is the United States from the rest of the OECD?","volume":"26","author":"White","year":"2007","journal-title":"Health Aff"},{"key":"2026091111370159100_qxag234-B15","author":"Smith","year":"2022"},{"issue":"1","key":"2026091111370159100_qxag234-B16","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1377\/hlthaff.2018.05144","article-title":"It's still the prices, stupid: why the US spends so much on health care, and a tribute to Uwe Reinhardt","volume":"38","author":"Anderson","year":"2019","journal-title":"Health Aff"},{"issue":"9","key":"2026091111370159100_qxag234-B17","doi-asserted-by":"publisher","first-page":"599","DOI":"10.2471\/BLT.18.209031","article-title":"Catastrophic health spending in Europe: equity and policy implications of different calculation methods","volume":"96","author":"Cylus","year":"2018","journal-title":"Bull World Health Organ"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag234\/70942685\/qxag234.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/9\/qxag234\/70942685\/qxag234.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/9\/qxag234\/70942685\/qxag234.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:37:10Z","timestamp":1789141030000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag234\/8781118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag234","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,9,1]]},"article-number":"qxag234"}}