OBJECTIVES: Lymphedema is a frequent and chronic condition posing a high burden on patients. Clinical guidelines emphasize the role of compression therapy by prescription medical devices. Even in a mandatory publicly funded health insurance system, out-of-pocket payments (OOPP) may exist due to the price and reimbursement setting processes. OOPP may threaten the equity of care and drive patients to forgo care. Our aim was to analyze the distributive effects of OOPP for lymphedema patients in France. METHODS: A prospective, multicenter study was conducted in France in 2014 on patients with lymphedema (the LYMPHORAC study). Household ability to pay was specified by net income and OOPP were assessed prospectively over 6 months for outpatient care (visits, drugs, medical devices, nursing care, biological tests, imaging, physiotherapy and transportations). Both mandatory and voluntary health insurance reimbursements were considered. We combined concentration curves and concentration indices to assess the distributive effects. RESULTS: We included 103 patients, the average age being 56 years. The average OOPP for outpatient care over 6 months was 183 Euros (SD: 191) out of which 80% due to prescription compression devices. OOPP represented a higher share of income in the poorer quintile as compared to the richer one (p<0.01). OOPP had a regressive effect on income distribution with a concentration index equal to 0.13 after reimbursement by the mandatory health insurance scheme and equal to 0.14 after complementary reimbursement by the voluntary schemes. 21% of patients declared having forgone lymphedema medical care because of cost during the study. CONCLUSIONS: Even in a health care system organized and financed to warrant equity, OOPP have a regressive distributive effect in patients with lymphedema, mainly because of prescription medical devices. This regressive effect is amplified by voluntary health insurance schemes.