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Impact of forgoing care because of costs on the quality of diabetes care: A three-year cohort study

Published:March 12, 2017DOI:https://doi.org/10.1016/j.ejim.2017.03.007
      Forgoing care because of costs is a frequent situation in many countries, with estimated prevalences going from 4% to 30% [
      • Schoen C.
      • Osborn R.
      • Squires D.
      • Doty M.M.
      Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries.
      ,
      • Shi L.
      • Stevens G.D.
      Vulnerability and unmet health care needs.
      ,
      • Peytremann-Bridevaux I.
      • Chevrou-Severac H.
      Financial burden of medical care and risk of forgoing care among Europeans with depressive symptoms.
      ,
      • Osborn R.
      • Moulds D.
      The commonwealth fund 2014 health policy survey of older adults in eleven countries.
      ,
      • Bodenmann P.
      • Favrat B.
      • Wolff H.
      • Guessous I.
      • Panese F.
      • et al.
      Screening primary-care patients forgoing health care for economic reasons.
      ,
      • Guessous I.
      • Gaspoz J.M.
      • Theler J.M.
      • Wolff H.
      High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage.
      ]. It can be defined as a decision of not seeking care when needed because of financial reasons and the term is used interchangeably with unmet needs as both terms provide similar information [
      • Allin S.
      • Masseria C.
      Unmet need as an indicator of health care access.
      ]. Whereas most studies on the prevalence of forgoing care because of costs target the general populations, little is known of the prevalence of forgoing care for people with specific chronic conditions. The few studies exploring this issue reported a prevalence close to general population figures [
      • Bodenmann P.
      • Favrat B.
      • Wolff H.
      • Guessous I.
      • Panese F.
      • et al.
      Screening primary-care patients forgoing health care for economic reasons.
      ,
      • Röttger J.
      • Blümel M.
      • Köppen J.
      • Busse R.
      Forgone care among critically ill patients in Germany – results from a cross-sectional survey with 15,565 individuals.
      ,
      • Galbraith A.A.
      • Soumerai S.B.
      • Ross-Degnan D.
      • Rosenthal M.B.
      • Gay C.
      • et al.
      Delayed and forgone care for families with chronic conditions in high-deductible health plans.
      ]. As people with chronic conditions have a high demand of health care, such prevalence may either be lower, since they are being followed by a health practitioner and are already navigating the system, or on the contrary, may be similar or higher, since they might decide to prioritize some health issues at the expense of other conditions.

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