Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24–27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public.

The Shapley value for airport and irrigation games

In this paper cost sharing problems are considered. We focus on problems given by rooted trees, we call these problems cost-tree problems, and on the induced transferable utility cooperative games, called irrigation games. A formal notion of irrigation games is introduced, and the characterization of the class of these games is provided. The well-known class of airport games Littlechild and Thompson (1977) is a subclass of irrigation games. The Shapley value Shapley (1953) is probably the most popular solution concept for transferable utility cooperative games. Dubey (1982) and Moulin and Shenker (1992) show respectively, that Shapley's Shapley (1953) and Young (1985)'s axiomatizations of the Shapley value are valid on the class of airport games. In this paper we show that Dubey (1982)'s and Moulin and Shenker (1992)'s results can be proved by applying Shapley (1953)'s and Young (1985)'s proofs, that is those results are direct consequences of Shapley (1953)'s and Young (1985)'s results. Furthermore, we extend Dubey (1982)'s and Moulin and Shenker (1992)'s results to the class of irrigation games, that is we provide two characterizations of the Shapley value for cost sharing problems given by rooted trees. We also note that for irrigation games the Shapley value is always stable, that is it is always in the core Gillies (1959).