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

  • Original article
  • Published:
International Journal of Public Health

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.

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Funding

The CONSTANCES Cohort Project is supported and funded by the Caisse nationale d’assurance maladie des travailleurs salariés (CNAMTS), the French Ministry of Health, the Council of the Ile de France Region, and by the Cohorts TGIR IReSP-ISP INSERM (Ministère de la Santé et des Sports, Ministère Délégué à la Recherche, Institut National de la Santé Et de la Recherche Médicale, Institut National du Cancer et Caisse Nationale de Solidarité pour l’Autonomie). CONSTANCES has also received funding from the French Commissariat Géneral à l’Investissement (Contrat ANR-11-INBS-0002). CONSTANCES also receives funding from MSD, AstraZeneca and Lundbeck managed by INSERM-Transfert. We, authors of this paper, do not have direct competing interest with AstraZeneca, MSD and Lundbeck related to the topic of this paper.

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Authors and Affiliations

  1. Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France

    Anne-Laure Feral-Pierssens, Joane Matta, Marcel Goldberg & Marie Zins

  2. Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France

    Anne-Laure Feral-Pierssens & Philippe Juvin

  3. Improving Emergency Care – IMPEC federation, Paris, France

    Anne-Laure Feral-Pierssens & Philippe Juvin

  4. Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France

    Claire Rives-Lange, Claire Carette & Sebastien Czernichow

  5. Paris University, Paris, France

    Claire Rives-Lange, Marcel Goldberg, Philippe Juvin, Marie Zins & Sebastien Czernichow

  6. Département Epidémiologie et Systèmes de Santé, UniSanté, Lausanne, Switzerland

    Victor G. Rodwin

  7. Wagner School of Public Service, New York University, New York, USA

    Victor G. Rodwin

  8. INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France

    Claire Rives-Lange & Sebastien Czernichow

  9. CIC1418, INSERM, Georges Pompidou European Hospital, Paris, France

    Claire Carette

Authors
  1. Anne-Laure Feral-Pierssens
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  2. Claire Rives-Lange
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  3. Joane Matta
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  4. Victor G. Rodwin
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  5. Marcel Goldberg
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  6. Philippe Juvin
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  7. Marie Zins
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  8. Claire Carette
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  9. Sebastien Czernichow
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Corresponding author

Correspondence to Anne-Laure Feral-Pierssens.

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Conflict of interest

SC holds shares of MyGoodLife®. The other authors declare no competing interests.

Ethical approval and Informed consent

We follow the STROBE recommendations for reporting observational cohort studies. Our analyses used Stata version 14.0 (StatCorp Ltd, College Station, USA). The CONSTANCES study was approved by the Comité Consultatif pour le Traitement des Informations Relatives à la Santé (CCTIRS) and the Commission Nationale Informatique et Liberté (CNIL). All participants signed an informed consent form.

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Feral-Pierssens, AL., Rives-Lange, C., Matta, J. et al. Forgoing health care under universal health insurance: the case of France. Int J Public Health 65, 617–625 (2020). https://doi.org/10.1007/s00038-020-01395-2

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  • DOI: https://doi.org/10.1007/s00038-020-01395-2

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