Screening Primary-Care Patients Forgoing Health Care for Economic Reasons

Abstract

BackgroundGrowing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources.ObjectivesIdentify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation.DesignMulticenter cross-sectional survey.ParticipantsForty-seven general practitioners working in the French–speaking part of Switzerland enrolled a random sample of patients attending their private practices.Main MeasuresPatients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels.Key ResultsOverall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4–12.1) reported a member of their household to have forgone health care during the 12 previous months. The question “Did you have difficulties paying your household bills during the last 12 months” performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R2 = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times.ConclusionGeneral practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.

Validity and Reliability of Turkish Version of Deprivation in Primary Care Questionnaire (DiPCare–Q)

“…20 DiPCare-Q, yoksul bireylerin belirlenmesinde geçerli ve güvenilir bir veri toplama aracı olarak birçok çalışmada kullanılmıştır. 23,24 Ancak Boyer ve arkadaşları (2014) internet erişiminin (madde 12) veya sinemaya gitmenin (madde 9) yoksulluğun işareti olmadığını, kişisel tercihi yansıtabileceğini belirtmektedir. 12 Bahsedilen maddelerin DiPCare-Q'da sosyal yoksunluk boyutunda değerlendirildiği ve sosyal yoksunluğun daha önce bahsedilen nedenlerle sağlık çıktıları üzerindeki kanıtlanmış etkisi düşünülürse bu eleştiriyi haklı olarak değerlendirmek mümkün değildir.…”

Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals

“…These indicate an association between higher rates of forgone care and female gender, younger age, rural living area, unemployment, low educational level, low income and poor health [4,9,[16][17][18][19][20][21].…”

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

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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].

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“…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.…”