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Short communication

Vol. 141 No. 0708 (2011)

Health care renunciation for economic reasons in Switzerland

  • I Guessous
DOI
https://doi.org/10.4414/smw.2011.13165
Cite this as:
Swiss Med Wkly. 2011;141:w13165
Published
14.02.2011

Summary

BACKGROUND: Most societies elaborate ways to contain increasing health care expenditures. In Switzerland out of pocket payments and cuts in the catalogue of reimbursed services are used as cost-containment measures. The aims of the study were to estimate the extent of health care renunciation for economic reasons and to identify associated factors.

METHODS:A population-based cross-sectional survey (2008–2009) of a representative sample in the Canton of Geneva, Switzerland. Health care underuse, income level categories (<CHF 3000/month, 3000–4999, 5000–6999, 7000–9499, 9500–13 000, >13 000), education, occupation, insurance status and cardiovascular comorbidities were collected using self-rated questionnaires.

RESULTS:765 men and 814 women aged 35–74 years participated. 14.5% (229/1579) (95%CI 12.7-16.2) renounced health care for economic reasons. Among those who renounced (N = 229), 74% renounced dental care, 37% physician consultation (22% specialist, 15% general practitioner), 26% health devices, 13% medication, and 5% surgery. Income was negatively correlated with renouncement (r = –0.18, p <.0001). Each decrease in income level category provided a 48% increased risk of renouncing health care for economic reasons (OR 1.48, 1.31–1.65). This association remained when dental care was excluded from the definition of health care renunciation.

CONCLUSIONS:In a region of Switzerland with a high cost of living, such as Geneva, socioeconomic status may influence the use of the health care system, and renunciation for economic reasons was not uncommon. More than 30% of the lowest income group renounced health care for economical reasons in the previous year. Health care underuse and renunciation may worsen the health status of a substantial part of society.

References

  1. OECD. OECD and WHO survey of Switzerland’s health system. http://www.oecd.org/document/47/0,2340,en_2649_201185_37562223_1_1_1_1,00.html. 19-10-2006.
  2. Reinhardt UE. The Swiss health system: regulated competition without managed care. JAMA. 2004;292(10):1227–31.
  3. Office cantonal de la statistique. Prestations allouées dans le cadre de la réduction individuelle de primes et bénéficiaires de réductions individuelles de primes dans l'assurance obligatoire des soins LAMal (AOS), par canton, depuis 1999. http://www.ge.ch/statistique/tel/domaines/13/13_03_3/T_13_03_3_6_02.xls. 2010.
  4. Federal Office of Public Health. Kantonale Durchschnittsprämien 2010/2011 der oblig. Krankenpflegeversicherung. http://www.bag.admin.ch/themen/krankenversicherung/00261/index.html?lang=de. 2010.
  5. Swiss Federal Statistical Office. Krankenversicherungsprämien – Daten, Indikatoren. http://www.bfs.admin.ch/bfs/portal/de/index/themen/05/03/blank/key/index.html. 2010.
  6. Wilkinson R, Marmot M. Social determinants of health: the solid facts. World Health Organization, Europe 2003; 2. edition: 10–25.
  7. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104.
  8. Wagstaff A, Van Doorslaer E. Income inequality and health: what does the literature tell us? Annu Rev Public Health. 2000;21:543–67.
  9. Van Doorslaer E, Wagstaff A, van der BH, Christiansen T, De Graeve D, Duchesne I, et al. Equity in the delivery of health care in Europe and the US. J Health Econ. 2000;19(5):553–83.
  10. Heisler M, Choi H, Rosen AB, Vijan S, Kabeto M, Langa KM, et al. Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. Med Care. 2010;48(2):87–94.
  11. Galobardes B, Costanza MC, Bernstein MS, Delhumeau CH, Morabia A. Trends in risk factors for the major “lifestyle-related diseases” in Geneva, Switzerland, 1993–2000. Ann Epidemiol. 2003;13(7):537–40.
  12. Galobardes B, Costanza MC, Bernstein MS, Delhumeau C, Morabia A. Trends in risk factors for lifestyle-related diseases by socioeconomic position in Geneva, Switzerland, 1993–2000: health inequalities persist. Am J Public Health. 2003;93(8):1302–9.
  13. Baroletti S, Dell'Orfano H. Medication adherence in cardiovascular disease. Circulation. 2010;121(12):1455–8.
  14. Piette JD, Heisler M, Wagner TH. Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk. Am J Public Health. 2004;94(10):1782–7.
  15. Piette JD, Heisler M, Wagner TH. Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Arch Intern Med. 2004;164(16):1749–55.
  16. Cummings JR, Lavarreda SA, Rice T, Brown ER. The effects of varying periods of uninsurance on children's access to health care. Pediatrics. 2009;123(3):e411–e418.
  17. Van Doorslaer E, Masseria C, Koolman X. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174(2):177–83.
  18. Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991;114(4):325–31.
  19. Epstein AM, Stern RS, Weissman JS. Do the poor cost more? A multihospital study of patients' socioeconomic status and use of hospital resources. N Engl J Med. 1990;322(16):1122–8.
  20. Destefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ. 1993;306(6879):688–91.
  21. Madrid C, Abarca M, Pop S, Bodenmann P, Wolff H, Bouferrache K. Oral health: social determinants of a health inequality. Rev Med Suisse. 2009;5(219):1946–51.
  22. Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(5):559–69.