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Patient charges -- a hindrance to financially and psychosocially disadvantage groups seeking care


  • Elofsson, Stig
  • Undén, Anna-Lena
  • Krakau, Ingvar


This study examines the extent to which people forego seeking primary health care due to the cost and to investigate the associated demographic, physical, psychological and social factors. In 1995, questionnaires were sent to a random sample of the population in two healthcare regions in the Stockholm area in Sweden covering a total of about 400[punctuation space]000 inhabitants. Among the sample of 8200 people over the age of 17Â yr, 69% replied to the questionnaire. About 22% stated that on one or more occasions during the past year they had foregone seeking care due to the cost. About 30% stated that they had foregone or hesitated seeking medical help due to the cost during the past year. This applied to women to a greater extent than men. Not seeking medical care was strongly correlated to a self-assessment of personal finances. Among those who described their financial situation as poor, more than half stated that, on at least one occasion, they had foregone seeking medical care due to the cost. As a consequence, weaker groups in society such as the unemployed, students, foreign nationals and single mothers were overrepresented in this group. Those who had foregone care perceive their health as worse and they had a greater degree of general pains and a higher occurrence of chronic disease/disability compared to those who had not foregone care. Between 1970 and 1995, patient charges for consulting a general practitioner within Stockholm County have increased more than three times faster than the consumer price index. The results suggest that the rapidly increasing patient charges particularly affect the weaker social groups and thus pose a threat to the aim of Swedish healthcare legislation -- that good care should be available to everyone on equal terms.

Suggested Citation

  • Elofsson, Stig & Undén, Anna-Lena & Krakau, Ingvar, 1998. "Patient charges -- a hindrance to financially and psychosocially disadvantage groups seeking care," Social Science & Medicine, Elsevier, vol. 46(10), pages 1375-1380, March.
  • Handle: RePEc:eee:socmed:v:46:y:1998:i:10:p:1375-1380

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    Cited by:

    1. Anders Anell, 2005. "Swedish healthcare under pressure," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 237-254.
    2. Paul, Alexander & Nilsson, Anton, 2014. "The Effect of Copayments on Children's and Adolescents' Demand for Medical Care," Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100403, Verein für Socialpolitik / German Economic Association.
    3. Schreyögg, Jonas & Grabka, Markus M., 2010. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," EconStor Open Access Articles, ZBW - German National Library of Economics, pages 331-341.
    4. Wren, Maev-Ann & Connolly, Sheelagh & Cunningham, Nathan, 2015. "An Examination of the Potential Costs of Universal Health Insurance in Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS45.
    5. Benning, Tim M. & Dellaert, Benedict G.C., 2013. "Paying more for faster care? Individuals' attitude toward price-based priority access in health care," Social Science & Medicine, Elsevier, vol. 84(C), pages 119-128.
    6. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," Working Papers hal-01256505, HAL.
    7. repec:eee:hepoli:v:121:y:2017:i:5:p:543-552 is not listed on IDEAS
    8. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    9. Vicky Barham & Hana Bataineh & Rose Anne Devlin, 2017. "Unmet Health Care and Health Care Utilization," Working Papers 1716E, University of Ottawa, Department of Economics.
    10. Poulsen, Camilla Aavang, 2014. "Introducing out-of-pocket payment for General Practice in Denmark: Feasibility and support," Health Policy, Elsevier, vol. 117(1), pages 64-71.
    11. Westin, Marcus & Ahs, Annika & Brand Persson, Kristina & Westerling, Ragnar, 2004. "A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?," Health Policy, Elsevier, vol. 68(3), pages 333-344, June.
    12. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," CEPN Working Papers hal-01256505, HAL.


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