High prevalence of forgoing healthcare for economic reasons in Switzerland: A population-based study in a region with universal health insurance coverage

Guessous, Idris; Gaspoz, Jean‐Michel; Théler, Jean-Marc; Wolff, Hans

doi:10.1016/j.ypmed.2012.08.005

Cited by 72 publications

(95 citation statements)

References 14 publications

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“…Moreover, the socio-demographics, household income and subjective health of this study's participants reporting forgoing care because of costs were similar to previous studies not targeting specifically persons with diabetes [6]. Whereas participants who declared forgoing care at baseline, reported suggestive evidence of high healthcare utilization and worse (health-related) quality of life, compared to participants not forgoing care, the three-year evolution over time did not seem to impact the medium-term quality of care of these persons, even when considering potential confounding variables.…”

supporting

confidence: 78%

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Impact of forgoing care because of costs on the quality of diabetes care: A three-year cohort study

Rosselet

Zuercher

Pasquier

et al. 2017

European Journal of Internal Medicine

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Forgoing care because of costs is a frequent situation in many countries, with estimated prevalences going from 4% to 30% [1][2][3][4][5][6]. It can be defined as a decision of not seeking care when needed because of financial reasons and the term is used interchangeably with unmet needs as both terms provide similar information [7]. Whereas most studies on the prevalence of forgoing care because of costs target the general populations, little is known of the prevalence of forgoing care for people with specific chronic conditions. The few studies exploring this issue reported a prevalence close to general population figures [5,[8][9]. As people with chronic conditions have a high demand of health care, such prevalence may either be lower, since they are being followed by a health practitioner and are already navigating the system, or on the contrary, may be similar or higher, since they might decide to prioritize some health issues at the expense of other conditions.Our main objective was to assess the prevalence of forgoing care because of costs in Swiss patients with diabetes; a secondary objective was to explore whether forgoing care because of costs was related to a risk of worsening the quality of their care after three years of follow-up.We used data from a prospective Swiss cohort study, the CoDiab-VD cohort, consisting of non-institutionalized adults with a diagnosis of diabetes of at least one-year duration and residing in the canton of Vaud (≈ 750'000 inhabitants). Participants were recruited in 2011-2012 by community-based pharmacies and are followed-up yearly [10]. Study data were collected from paper-based questionnaires sent to participants' home. All variables, described in details elsewhere [10], are briefly presented thereafter. The primary exposure variable of the study was forgoing care because of costs at baseline, 3 measured using the following question: "During the last twelve months, did you forgo any type of care because of the costs you would have to pay?" Participants were considered to have forgone care during the past 12 months if they answered "yes" to that question. We considered eight diabetes-specific processes of care (e.g. HbA1c control, annual foot examination) and five outcomes of care (e.g. mean HbA1c, generic and disease-specific health-related quality of life) as dependent variables, and other covariates (e.g. age, gender, socio-demographics) [10]. The prevalence (and 95% confidence interval) of forgoing care and the type of care forgone were calculated.Then, bivariate analyses were conducted to compare participants forgoing vs not forgoing care. Finally, crude and adjusted mixed logistic and linear regression models were used to assess the over time effect of forgoing care on the dichotomous and continuous processes and outcomes of care indicators, respectively.At baseline, results showed a prevalence of persons reporting having forgone care because of costs of 15.7% (95% CI 12.5%-18.9%), with dental (9.7%) and foot (5.2%) care most often reported to have been forgone (oth...

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confidence: 78%

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mentioning

confidence: 99%

Impact of forgoing care because of costs on the quality of diabetes care: A three-year cohort study

Rosselet

Zuercher

Pasquier

et al. 2017

European Journal of Internal Medicine

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“…This could be explained by more negative attitudes toward cancer screening among the socio-economically disadvantaged 25 . Despite the mandatory Swiss health insurance system, deductibles imply that part of the costs can be at the patient’s charge and women may therefore forgo medical visits for economic reasons 26 . The stability of differences over waves between women in lower and higher social positions suggests that health inequalities, as measured by screening attendance, are not changing in Switzerland.…”

Section: Discussionmentioning

confidence: 99%

Cervical cancer screening in Switzerland: cross-sectional trends (1992–2012) in social inequalities

Burton-Jeangros

Cullati

Manor

et al. 2016

Eur J Public Health

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Background: Incidence and mortality of cervical cancer declined thanks to Pap smear screening. However cervical cancer screening (CCS) inequalities are documented, including in high income countries. This population-based study aims to assess the importance and 20-year trends of CCS inequalities in Switzerland, where healthcare costs and medical coverage are among the highest in the world. Methods: We analyzed data from five waves of the population-based Swiss Health Interview Survey (SHIS) covering the period 1992–2012. Multivariable Poisson regression were used to estimate weighted prevalence ratios (PR) of CCS and 95% Confidence Intervals (CI) adjusting for socio-economic, socio-demographic characteristics, family status, health status, and use of healthcare. Results: The study included 32’651 women aged between 20 and 70 years old. Between 1992 and 2012, rates of CCS over the past 3 years fluctuated between 71.7 and 79.6% (adjusted P < 0.001). Lower CCS was observed among women with low education, low income, those having limited emotional support, who were non-Swiss, single, older, living in non-metropolitan area or in the French-speaking region, overweight. Over the analyzed period, differences in CCS across age groups diminished while rates among women who visited a GP over the previous year, versus those who did not, increased. Conclusions: While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012. At the same time, inequalities in CCS persisted over that period.

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“…Individuals are responsible for a 10% co-payment after their annual deductible, which ranges from 300-2500 CHF, is met. A recent study reports that despite universal health care, 13% of Swiss forgo healthcare for economic reasons and that the proportion of healthcare forgone due to economic reasons among those with lower income (30%) was significantly greater compared to those with the highest income (4%) (Guessous et al, 2012). Thus, in addition to mechanisms listed above, respondents with higher SES could be less likely to forgo PCa screening than respondents with lower SES.…”

Section: -2012 Determinants Of Pca Screeningmentioning

confidence: 99%

Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities

Guessous

Cullati

Fedewa

et al. 2016

Preventive Medicine

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Despite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators

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High prevalence of forgoing healthcare for economic reasons in Switzerland: A population-based study in a region with universal health insurance coverage

Cited by 72 publications

References 14 publications

Impact of forgoing care because of costs on the quality of diabetes care: A three-year cohort study

Impact of forgoing care because of costs on the quality of diabetes care: A three-year cohort study

Cervical cancer screening in Switzerland: cross-sectional trends (1992–2012) in social inequalities

Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities

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