title: Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers.
abstract: OBJECTIVE
  This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, The Netherlands, New Zealand, the United Kingdom, and the United States.
  
  
  METHODS
  The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models.
  
  
  RESULTS
  Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In The Netherlands and UK, cost barriers are only a marginal phenomenon.
  
  
  CONCLUSIONS
  The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems.
authors.affiliation: Department of Sociology, University of Siegen, Siegen, Germany. wendt@soziologie.uni-siegen.de
authors.forename: Claus
authors.initials: C
authors.lastname: Wendt
authors.forename: Monika
authors.initials: M
authors.lastname: Mischke
authors.forename: Michaela
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Nadine
authors.initials: N
authors.lastname: Reibling
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D001315:Australia; D002170:Canada; D016638:Critical Illness / Q000191:economics / Q000523:psychology* / Q000628:therapy; D004522:Educational Status; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D006304:Health Status; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D009520:New Zealand; D012737:Sex Factors; D012959:Socioeconomic Factors; D006113:United Kingdom; D014481:United States; D055815:Young Adult