TY - JOUR
T1 - Forgoing health care under universal health insurance
T2 - the case of France
AU - Feral-Pierssens, Anne Laure
AU - Rives-Lange, Claire
AU - Matta, Joane
AU - Rodwin, Victor G.
AU - Goldberg, Marcel
AU - Juvin, Philippe
AU - Zins, Marie
AU - Carette, Claire
AU - Czernichow, Sebastien
N1 - Publisher Copyright:
© 2020, Swiss School of Public Health (SSPH+).
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Objectives: We investigate the reliability of a survey question on forgone healthcare services for financial reasons, based on analysis of actual healthcare use over the 3-year period preceding response to the question. We compare the actual use of different health services by patients who report having forgone health care to those who do not. Methods: Based on a prospective cohort study (CONSTANCES), we link survey data from enrolled participants to the Universal Health Insurance (UHI) claims database and compare use of health services of those who report having forgone health care to controls. We present multivariable logistic regression models and assess the odds of using different health services. Results: Compared to controls, forgoing care participants had lower odds of consulting GPs (OR = 0.83; 95% CI 0.73, 0.93), especially specialists outside hospitals (gynecologists: 0.74 (0.69, 0.78); dermatologists: 0.81 (0.78–0.85); pneumologists 0.82 (0.71–0.94); dentists 0.71 (0.68, 0.75)); higher odds of ED visits (OR = 1.25; 95% CI 1.19, 1.31); and no difference in hospital admissions (OR = 1.02; 95% CI 0.97, 1.09). Participants with lower occupational status and income had higher odds of forgoing health care. Conclusions: The perception of those who report having forgone health care for financial reasons is consistent with their lower actual use of community-based ambulatory care (CBAC). While UHI may be necessary to improve healthcare access, it does not address the social factors associated with the population forgoing health care for financial reasons.
AB - Objectives: We investigate the reliability of a survey question on forgone healthcare services for financial reasons, based on analysis of actual healthcare use over the 3-year period preceding response to the question. We compare the actual use of different health services by patients who report having forgone health care to those who do not. Methods: Based on a prospective cohort study (CONSTANCES), we link survey data from enrolled participants to the Universal Health Insurance (UHI) claims database and compare use of health services of those who report having forgone health care to controls. We present multivariable logistic regression models and assess the odds of using different health services. Results: Compared to controls, forgoing care participants had lower odds of consulting GPs (OR = 0.83; 95% CI 0.73, 0.93), especially specialists outside hospitals (gynecologists: 0.74 (0.69, 0.78); dermatologists: 0.81 (0.78–0.85); pneumologists 0.82 (0.71–0.94); dentists 0.71 (0.68, 0.75)); higher odds of ED visits (OR = 1.25; 95% CI 1.19, 1.31); and no difference in hospital admissions (OR = 1.02; 95% CI 0.97, 1.09). Participants with lower occupational status and income had higher odds of forgoing health care. Conclusions: The perception of those who report having forgone health care for financial reasons is consistent with their lower actual use of community-based ambulatory care (CBAC). While UHI may be necessary to improve healthcare access, it does not address the social factors associated with the population forgoing health care for financial reasons.
KW - Access to care
KW - Social deprivation
KW - Universal Health Insurance (UHI)
KW - Unmet healthcare needs
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U2 - 10.1007/s00038-020-01395-2
DO - 10.1007/s00038-020-01395-2
M3 - Article
C2 - 32474715
AN - SCOPUS:85085890628
SN - 1661-8556
VL - 65
SP - 617
EP - 625
JO - International Journal of Public Health
JF - International Journal of Public Health
IS - 5
ER -