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

Author

Listed:
  • Anne-Laure Feral-Pierssens

    (INSERM UMS 11
    Georges Pompidou European Hospital
    Improving Emergency Care – IMPEC federation)

  • Claire Rives-Lange

    (Georges Pompidou European Hospital, Centre Spécialisé Obésité
    Paris University
    INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team)

  • Joane Matta

    (INSERM UMS 11)

  • Victor G. Rodwin

    (UniSanté
    New York University)

  • Marcel Goldberg

    (INSERM UMS 11
    Paris University)

  • Philippe Juvin

    (Georges Pompidou European Hospital
    Improving Emergency Care – IMPEC federation
    Paris University)

  • Marie Zins

    (INSERM UMS 11
    Paris University)

  • Claire Carette

    (Georges Pompidou European Hospital, Centre Spécialisé Obésité
    CIC1418, INSERM, Georges Pompidou European Hospital)

  • Sebastien Czernichow

    (Georges Pompidou European Hospital, Centre Spécialisé Obésité
    Paris University
    INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team)

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.

Suggested Citation

  • Anne-Laure Feral-Pierssens & Claire Rives-Lange & Joane Matta & Victor G. Rodwin & Marcel Goldberg & Philippe Juvin & Marie Zins & Claire Carette & Sebastien Czernichow, 2020. "Forgoing health care under universal health insurance: the case of France," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 65(5), pages 617-625, June.
    • Handle: RePEc:spr:ijphth:v:65:y:2020:i:5:d:10.1007_s00038-020-01395-2
    DOI: 10.1007/s00038-020-01395-2
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    References listed on IDEAS

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    1. Olivier Nay & Sophie Béjean & Daniel Benamouzig & Henri Bergeron & Patrick Castel & Bruno Ventelou, 2016. "Archieving universal health coverage in France: policy reforms and the challenge of inequalities," Post-Print hal-01318942, HAL.
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