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Screening Primary-Care Patients Forgoing Health Care for Economic Reasons

Author

Listed:
  • Patrick Bodenmann
  • Bernard Favrat
  • Hans Wolff
  • Idris Guessous
  • Francesco Panese
  • Lilli Herzig
  • Thomas Bischoff
  • Alejandra Casillas
  • Thomas Golano
  • Paul Vaucher

Abstract

Background: Growing 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. Objectives: Identify 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. Design: Multicenter cross-sectional survey. Participants: Forty-seven general practitioners working in the French–speaking part of Switzerland enrolled a random sample of patients attending their private practices. Main Measures: Patients 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 Results: Overall, 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. Conclusion: General 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.

Suggested Citation

  • Patrick Bodenmann & Bernard Favrat & Hans Wolff & Idris Guessous & Francesco Panese & Lilli Herzig & Thomas Bischoff & Alejandra Casillas & Thomas Golano & Paul Vaucher, 2014. "Screening Primary-Care Patients Forgoing Health Care for Economic Reasons," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    • Handle: RePEc:plo:pone00:0094006
    DOI: 10.1371/journal.pone.0094006
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    1. 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.
    2. Shiho Kino & Eduardo Bernabé & Wael Sabbah, 2019. "Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries," IJERPH, MDPI, vol. 16(23), pages 1-9, November.
    3. Haeger, Christine & Kohl, Raphael & O'Sullivan, Julie L. & Schnitzer, Susanne, 2025. "Forgone Care of doctor's visits in Germany – Results from three cross-sectional surveys," Health Policy, Elsevier, vol. 155(C).
    4. Nie, Peng & Li, Qiaoge, 2022. "Energy Poverty and Health Care Expenditures: Evidence from the China Family Panel Studies," IZA Discussion Papers 15479, Institute of Labor Economics (IZA).
    5. Anne-Laure Feral-Pierssens & Claire Rives-Lange & Joane Matta & Victor G. Rodwin & Marcel Goldberg & Philippe Juvin & Marie Zins & Claire Carette & Sebastien Czernichow, 0. "Forgoing health care under universal health insurance: the case of France," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 0, pages 1-9.
    6. Silja Leiser & Anouk Déruaz-Luyet & A Alexandra N’Goran & Jérôme Pasquier & Sven Streit & Stefan Neuner-Jehle & Andreas Zeller & Dagmar M Haller & Lilli Herzig & Patrick Bodenmann, 2017. "Determinants associated with deprivation in multimorbid patients in primary care—A cross-sectional study in Switzerland," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-12, July.

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