Out of pocket spending of deceased cancer patients in 5 European countries and Israel

Cancer imposes a substantial economic burden on society, health and social care systems, patients and their families. This study aims to examine the out-of-pocket spending of cancer patients in their last year of life, in six countries with health insurance systems that have a defined benefits package.Data from SHARE and SHARE End-of-Life surveys, conducted between 2006 and 2015 among people aged 50+ were analyzed. Family members of deceased persons were interviewed in order to learn about the circumstances of their relative's death.This study found that out-of-pocket spending of cancer patients during their last year of life, in six developed countries with universal health insurance systems, is 4.5\of-pocket expenditures of the total household income: 2.2\ 4.3\ 5\ 5.1\ 5.1\.2\of-pocket spending on nursing home care was 7.8\ in the Netherlands and in Israel it was negligible. In contrast, the out-of-pocket spending for home care due to disability surged to 5.6\.7\ whereas in other countries it was very low.This is probably due to the split between the health and the social systems in Israel. The social security administration in Israel is responsible for financing personal care, and the patients have to apply for it themselves. Since the deterioration in functional ability of cancer patients might be quite rapid, many of them pay for professional assistance themselves, until they are approved as eligible for public funds, a process that may last a few weeks. This information is important to health and social policy makers, in order to better adapt the benefits package to the patients' needs.Cancer imposes a substantial economic burden during the last year of life. The economic burden varies across European countries with health insurance systems.Even countries with a universal benefits package take different approaches to prioritizing services and drugs for cancer care and leave some components of care to individual out-of- pocket payment.