title: Association between forgone care and household income among the elderly in five Western European countries - analyses based on survey data from the SHARE-study.
abstract: BACKGROUND
  Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups.
  
  
  METHODS
  The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older. Data are included from France, Germany, Greece, Italy and Sweden. The dependent variable is assessed by the following question: During the last twelve months, did you forgo any types of care because of the costs you would have to pay, or because this care was not available or not easily accessible? The main independent variable is household income, adjusted for household size and split into quintiles, calculating the quintile limits for each country separately. Information on age, sex, self assessed health and chronic disease is included as well. Logistic regression models were used for the multivariate analyses.
  
  
  RESULTS
  The overall level of forgone care differs considerably between the five countries (e.g. about 10 percent in Greece and 6 percent in Sweden). Low income groups report forgone care more often than high income groups. This association can also be found in analyses restricted to the subsample of persons with chronic disease. Associations between forgone care and income are particularly strong in Germany and Greece. Taking the example of Germany, forgone care in the lowest income quintile is 1.98 times (95% CI: 1.08-3.63) as high as in the highest income quintile.
  
  
  CONCLUSIONS
  Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance. These efforts should focus on population groups with particularly high prevalence of forgone care, for example on patients with poor self assessed health, on women, and on low income groups. The inter-country differences point to the need to specify different policy recommendations for different countries.
authors.affiliation: Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, PO Box 1129, 85758 Neuherberg, Germany. mielck@helmholtz-muenchen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
authors.forename: Raphael
authors.initials: R
authors.lastname: Kiess
authors.forename: Olaf
authors.initials: O
authors.lastname: von dem Knesebeck
authors.forename: Irina
authors.initials: I
authors.lastname: Stirbu
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D011795:Surveys and Questionnaires