IDEAS home Printed from https://ideas.repec.org/a/spr/ijphth/vyid10.1007_s00038-020-01395-2.html
   My bibliography  Save this article

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, 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.
    • Handle: RePEc:spr:ijphth:v::y::i::d:10.1007_s00038-020-01395-2
    DOI: 10.1007/s00038-020-01395-2
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s00038-020-01395-2
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s00038-020-01395-2?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    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.
    2. Paul Dourgnon & Florence Jusot & Romain Fantin, 2012. "Payer peut nuire à votre santé : une étude de l’impact du renoncement financier aux soins sur l’état de santé," Working Papers DT47, IRDES institut for research and information in health economics, revised Apr 2012.
    3. 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.
    4. Anne-Laure Feral-Pierssens & Claire Carette & Claire Rives-Lange & Joane Matta & Marcel Goldberg & Philippe Juvin & Marie Zins & Sebastien Czernichow, 2018. "Obesity and emergency care in the French CONSTANCES cohort," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-12, March.
    5. Gusmano, Michael K. & Weisz, Daniel & Rodwin, Victor G. & Lang, Jonas & Qian, Meng & Bocquier, Aurelie & Moysan, Veronique & Verger, Pierre, 2014. "Disparities in access to health care in three French regions," Health Policy, Elsevier, vol. 114(1), pages 31-40.
    6. repec:dau:papers:123456789/9221 is not listed on IDEAS
    7. Rodwin, V.G., 2003. "The health care system under French national health insurance: Lessons for health reform in the United States," American Journal of Public Health, American Public Health Association, vol. 93(1), pages 31-37.
    8. repec:dau:papers:123456789/10510 is not listed on IDEAS
    9. Allin, Sara & Grignon, Michel & Le Grand, Julian, 2010. "Subjective unmet need and utilization of health care services in Canada: What are the equity implications?," Social Science & Medicine, Elsevier, vol. 70(3), pages 465-472, February.
    10. Madureira-Lima, Joana & Reeves, Aaron & Clair, Amy & Stuckler, David, 2018. "The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis," LSE Research Online Documents on Economics 87740, London School of Economics and Political Science, LSE Library.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    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. Dourgnon, Paul, 2013. "Evaluation des politiques publiques et inégalités sociales d'accès aux services de santé," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/12221 edited by Wittwer, Jérôme.
    3. Grant Gibson & Michel Grignon & Jeremiah Hurley & Li Wang, 2019. "Here comes the SUN: Self‐assessed unmet need, worsening health outcomes, and health care inequity," Health Economics, John Wiley & Sons, Ltd., vol. 28(6), pages 727-735, June.
    4. L. F. Andrade & T. Rapp & C. Sevilla-Dedieu, 2018. "Quality of diabetes follow-up care and hospital admissions," International Journal of Health Economics and Management, Springer, vol. 18(2), pages 153-167, June.
    5. Field, Robert I. & Keller, Catherine & Louazel, Michel, 2020. "Can governments push providers to collaborate? A comparison of hospital network reforms in France and the United States," Health Policy, Elsevier, vol. 124(10), pages 1100-1107.
    6. Meghisan-Toma Georgeta-Madalina & Toma Dorin, 2019. "Health Determinants and Unmet Needs for Health Care- towards e-Health Systems," Proceedings of the International Conference on Business Excellence, Sciendo, vol. 13(1), pages 1045-1057, May.
    7. Alex R. Horenstein & Manuel S. Santos, 2012. "A Cross-Country Analysis of Health Care Expenditures," Working Papers 2013-05, University of Miami, Department of Economics.
    8. Aaltonen, Katri & Vaalavuo, Maria, 2024. "Financial burden of medicines in five Northern European countries: A decommodification perspective," Social Science & Medicine, Elsevier, vol. 347(C).
    9. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    10. Quintal, Carlota & Lourenço, Óscar & Ramos, Luís Moura & Antunes, Micaela, 2019. "No unmet needs without needs! Assessing the role of social capital using data from European social survey 2014," Health Policy, Elsevier, vol. 123(8), pages 747-755.
    11. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    12. Setti Rais Ali & Paul Dourgnon & Lise Rochaix, 2018. "Social Capital or Education: What Matters Most to Cut Time to Diagnosis?," Working Papers halshs-01703170, HAL.
    13. Azharuddin Akhtar & Indrani Roy Chowdhury, 2023. "The socioeconomic inequity in healthcare utilization among individuals with cardiovascular diseases in India," Health Economics, John Wiley & Sons, Ltd., vol. 32(5), pages 1000-1018, May.
    14. Farah N. Mawani & Patricia O’Campo & Peter Smith, 2022. "Opportunity Costs: Underemployment and Mental Health Inequities Between Immigrant and Canadian-Born Labour Force Participants: A Cross-Sectional Study," Journal of International Migration and Integration, Springer, vol. 23(3), pages 1443-1470, September.
    15. Sugeng Setyadi & Saharuddin Didu & Lili Indriyani & Ananda Kurnia Fitri & Anita Wiidiastuti, 2023. "Modeling Life Expectancy in Indonesia Using System GMM Model," Review of Applied Socio-Economic Research, Pro Global Science Association, vol. 25(1), pages 83-98, June.
    16. Marc Audi & Amjad Ali, 2023. "The Role of Environmental Conditions and Purchasing Power Parity in Determining Quality of Life among Big Asian Cities," International Journal of Energy Economics and Policy, Econjournals, vol. 13(3), pages 292-305, May.
    17. Gibson, Grant & Clair, Luc, 2019. "O brother how art thou: Propensity to report self-assessed unmet need," Social Science & Medicine, Elsevier, vol. 243(C).
    18. Spencer, Sarah & Hollingbery, Tai & Bodner, Aidan & Hedden, Lindsay & Rudoler, David & Christian, Erin & Lavergne, M Ruth, 2024. "Evaluating engagement with equity in Canadian provincial and territorial primary care policies: Results of a jurisdictional scan," Health Policy, Elsevier, vol. 140(C).
    19. Rättö, Hanna & Kurko, Terhi & Martikainen, Jaana E. & Aaltonen, Katri, 2021. "The impact of a co-payment increase on the consumption of type 2 antidiabetics – A nationwide interrupted time series analysis," Health Policy, Elsevier, vol. 125(9), pages 1166-1172.
    20. Damiano Fiorillo, 2020. "Reasons for unmet needs for health care: the role of social capital and social support in some western EU countries," International Journal of Health Economics and Management, Springer, vol. 20(1), pages 79-98, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:ijphth:v::y::i::d:10.1007_s00038-020-01395-2. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.