Forgoing health care under universal health insurance: the case of France.
Int J Public Health
; 65(5): 617-625, 2020 Jun.
Article
em En
| MEDLINE
| ID: mdl-32474715
ABSTRACT
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
10_ODS3_salud_sexual_reprodutiva
/
1_ASSA2030
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2_ODS3
Base de dados:
MEDLINE
Assunto principal:
Visita a Consultório Médico
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Aceitação pelo Paciente de Cuidados de Saúde
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Cobertura Universal do Seguro de Saúde
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Acessibilidade aos Serviços de Saúde
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
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Equity_inequality
Limite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Int J Public Health
Ano de publicação:
2020
Tipo de documento:
Article