title: High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage.
abstract: OBJECTIVE
  To investigate the determinants and the 4-year evolution of the forgoing of healthcare for economic reasons in Switzerland.
  
  
  METHODS
  Population-based survey (2007-2010) of a representative sample aged 35-74 years in the Canton of Geneva, Switzerland. Healthcare forgone, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods.
  
  
  RESULTS
  A total of 2601 subjects were included in the analyses. Of the subjects, 13.8% (358/2601) reported having forgone healthcare for economic reasons, with the percentage varying from 3.7% in the group with a monthly income ≥ 13,000 CHF (1CHF ≈ 1$) to 30.9% in the group with a monthly income <3000 CHF. In subjects with a monthly income <3000 CHF, the percentage who had forgone healthcare increased from 22.5% in 2007/8 to 34.7% in 2010 (P trend=0.2). Forgoing healthcare for economic reasons was associated with lower income, female gender, smoking status, lower job position, having dependent children, being divorced and single, paying a higher deductible, and receiving a premium subsidy.
  
  
  CONCLUSIONS
  In a Swiss region with universal health insurance coverage, the reported prevalence of forgoing healthcare for economic reasons was high and greatly dependent on socioeconomic factors. Our data suggested an increasing trend among participants with the lowest income.
authors.affiliation: Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Switzerland. Idris.Guessous@hcuge.ch
authors.forename: I
authors.initials: I
authors.lastname: Guessous
authors.forename: J M
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: J M
authors.initials: JM
authors.lastname: Theler
authors.forename: H
authors.initials: H
authors.lastname: Wolff
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003669:Deductibles and Coinsurance / Q000191:economics*; D005260:Female; D005382:Financing, Personal; D006304:Health Status; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D013557:Switzerland; D019472:Universal Health Insurance / Q000191:economics*