Screening primary-care patients forgoing health care for economic reasons.
BACKGROUND
Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources.


OBJECTIVE
Identify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation.


METHODS
Multicenter cross-sectional survey.


METHODS
Forty-seven general practitioners working in the French-speaking part of Switzerland enrolled a random sample of patients attending their private practices.


METHODS
Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels.


RESULTS
Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R(2) = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times.


CONCLUSIONS
General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.
Vulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Patrick
P
Bodenmann
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Bernard
B
Favrat
Department of Community Medicine, Primary Care, and Emergency Medicine, University Hospital Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Hans
H
Wolff
Department of Community Medicine, Primary Care, and Emergency Medicine, University Hospital Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Idris
I
Guessous
Institute of the History of Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Francesco
F
Panese
Institute of General Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Lilli
L
Herzig
Institute of General Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Thomas
T
Bischoff
Vulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Alejandra
A
Casillas
Institute of General Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Thomas
T
Golano
Institute of Legal Medicine, School of Medicine, University of Geneva, Geneva, Switzerland.
Paul
P
Vaucher
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013557:Switzerland; D055815:Young Adult