title: The 'price signal' for health care is loud and clear: A cross-sectional study of self-reported access to health care by disadvantaged Australians.
abstract: OBJECTIVE
  To describe self-reported inability to access health care and factors associated with lack of access among a socioeconomically disadvantaged group.
  
  
  METHODS
  A cross-sectional survey with 906 adult clients of a large community welfare agency in New South Wales. Clients attending the service for emergency assistance completed a touchscreen survey.
  
  
  RESULTS
  Inability to access health care in the prior year was reported by more than one-third of the sample (38%), compared to the 5% found for the general population. Dentists (47%), specialists (43%) or GPs (29%) were the least accessible types of health care. The main reason for inability to access health care was cost, accounting for 60% of responses. Almost half (47%) the sample reported delayed or non-use of medicines due to cost. Increasing financial stress was associated with increased inability to access GP or specialist care, medicines and imaging. Higher anxiety scores were associated with inability to access health care, and with cost-related inability to access medicines and imaging.
  
  
  CONCLUSIONS
  For disadvantaged groups, cost-related barriers to accessing care are prominent and are disproportionately high - particularly regarding dentistry, specialist and GP care.
  
  
  CONCLUSIONS
  Improvements in health outcomes for disadvantaged groups are likely to require strategies to reduce cost-related barriers to health care.
authors.affiliation: Priority Research Centre in Health Behaviour, School of Medicine and Public Health, University of Newcastle, New South Wales.|Hunter Medical Research Institute, New South Wales.
authors.forename: Christine
authors.initials: C
authors.lastname: Paul
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, New South Wales.
authors.forename: Billie
authors.initials: B
authors.lastname: Bonevski
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, New South Wales.
authors.forename: Laura
authors.initials: L
authors.lastname: Twyman
authors.affiliation: Research School of Population Health, National Centre for Epidemiology & Population Health, Australian National University, Australian Capital Territory.
authors.forename: Catherine
authors.initials: C
authors.lastname: D'Este
authors.affiliation: Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Centre, United States.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Siahpush
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, New South Wales.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Guillaumier
authors.affiliation: Priority Research Centre in Health Behaviour, School of Medicine and Public Health, University of Newcastle, New South Wales.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bryant
authors.affiliation: Priority Research Centre in Health Behaviour, School of Medicine and Public Health, University of Newcastle, New South Wales.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fradgley
authors.affiliation: Hunter Medical Research Institute, New South Wales.
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D005249:Fees and Charges; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D057566:Self Report; D012946:Social Welfare; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations
keywords: cost of illness; health services accessibility; outpatient care; socioeconomically disadvantaged groups; underserved populations