Cost-related barriers to use of health services and prescription medicines in Finland: a cross-sectional survey.
BACKGROUND
The objective was to examine cost-related barriers to using health services and prescription medicines in Finland.


METHODS
A survey that examined adults' experiences of and opinions about the social security system was mailed to a random population-based sample of 5000 Finns aged 18-74 years. The survey assessed households' cost-related barriers to use of health services, prescription medicines and social assistance in the past year. The responses were adjusted for sociodemographic and health predictors by weighting and logistic regression.


RESULTS
Responses were received from 1770 households. In total, 18% had experienced at least one cost-related barrier; 11% did not fill a prescription, 8% did not go to hospital and 13% went without another form of treatment. Of respondents diagnosed with a disabling illness or impairment, 32% reported at least one cost-related barrier. Households with below-average income reported barriers twice as often as above-average income households, after adjusting for age and health. Lower income [lowest tertile, odds ratio (OR) 5.0 compared with highest tertile], fair/poor self-assessed health (fair/poor OR 7.1 compared with very good/good), younger age (18-34 years OR 3.8 compared with 65-74 years), lower education (primary OR 1.6 compared with tertiary) and female gender (OR 1.4) were significantly associated with more frequent cost-related barriers. Overall, 34% of households who encountered cost-related barriers had applied for and 17% had received social assistance.


CONCLUSIONS
Cost-related barriers were common among respondents with low income and/or poor health. These barriers may thus have a role in creating inequities in access to health care in Finland.
1 The Social Insurance Institution, Research Department, Helsinki, Finland katri.aaltonen@kela.fi.
Katri
K
Aaltonen
1 The Social Insurance Institution, Research Department, Helsinki, Finland.
Jani
J
Miettinen
1 The Social Insurance Institution, Research Department, Helsinki, Finland.
Ilpo
I
Airio
1 The Social Insurance Institution, Research Department, Helsinki, Finland.
Jaana E
JE
Martikainen
1 The Social Insurance Institution, Research Department, Helsinki, Finland.
Leena K
LK
Saastamoinen
2 School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland 3 Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland 4 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
J Simon
JS
Bell
2 School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland 3 Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Sirpa
S
Hartikainen
5 School of Pharmacy, University of Otago, Dunedin, New Zealand.
Pauline
P
Norris
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005387:Finland; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics*; D012959:Socioeconomic Factors; D055815:Young Adult
D055553:Prescription Drugs