Forgoing health care under universal health insurance: the case of France

Anne Laure Feral-Pierssens, Claire Rives-Lange, Joane Matta, Victor G. Rodwin, Marcel Goldberg, Philippe Juvin, Marie Zins, Claire Carette, Sebastien Czernichow

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)617-625
Number of pages9
JournalInternational Journal of Public Health
Issue number5
StatePublished - Jun 1 2020


  • Access to care
  • Social deprivation
  • Universal Health Insurance (UHI)
  • Unmet healthcare needs

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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