title: Health care renunciation for economic reasons in Switzerland.
abstract: 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, 9500-13000, >13000), 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.
authors.affiliation: Division of Primary Care, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Wolff
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: Idris
authors.initials: I
authors.lastname: Guessous
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003669:Deductibles and Coinsurance / Q000191:economics / Q000331:legislation & jurisprudence*; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class; D013557:Switzerland