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

Anne-Laure Feral-Pierssens (), Claire Rives-Lange (), Joane Matta (), Victor G. Rodwin (), Marcel Goldberg (), Philippe Juvin (), Marie Zins (), Claire Carette () and Sebastien Czernichow ()
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Anne-Laure Feral-Pierssens: INSERM UMS 11
Claire Rives-Lange: Georges Pompidou European Hospital, Centre Spécialisé Obésité
Joane Matta: INSERM UMS 11
Victor G. Rodwin: UniSanté
Marcel Goldberg: INSERM UMS 11
Philippe Juvin: Georges Pompidou European Hospital
Marie Zins: INSERM UMS 11
Claire Carette: Georges Pompidou European Hospital, Centre Spécialisé Obésité
Sebastien Czernichow: Georges Pompidou European Hospital, Centre Spécialisé Obésité

International Journal of Public Health, 2020, vol. 65, issue 5, No 16, 617-625

Abstract: 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.

Keywords: Access to care; Unmet healthcare needs; Universal Health Insurance (UHI); Social deprivation (search for similar items in EconPapers)
Date: 2020
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Citations: View citations in EconPapers (2)

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DOI: 10.1007/s00038-020-01395-2

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