title: Forgone care among chronically ill patients in Germany-Results from a cross-sectional survey with 15,565 individuals.
abstract: The decision not to seek health care although one feels that care is needed (forgone care), is influenced by various factors. Within the study "Responsiveness in ambulatory care" 15,565 chronically ill (coronary heart disease and/or type 2 diabetes) patients in Germany were surveyed in 2013. The survey included questions on forgone care, perceived discrimination when seeking care, net-income, subjective health status and subjective socioeconomic status (subSES). Survey data were linked on patient-level with administrative claims data by a German sickness fund. We applied multivariate binomial logistic regression analyses to assess the association between age, sex, comorbidities, living area, subjective health status, subSES, experienced discrimination, net-equivalent income and reported forgone care. The majority in the sample are men (71.4%), the average age is 69.4 (SD: 10.2) years and 14.1% reported forgone care. In the multivariate model, we find that younger age, female gender, perceived discrimination, depression, and a poor subjective health status increase the odds of reporting forgone care. Overall, our results suggest that a negative experience with the health care system, i.e. perceived discrimination/unfair treatment, are strong predictors of forgone care among the chronically ill.
authors.affiliation: Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany. Electronic address: julia.roettger@tu-berlin.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Röttger
authors.affiliation: Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Blümel
authors.affiliation: Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Köppen
authors.affiliation: Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D005858:Germany; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Chronic diseases; Coronary heart disease; Forgone care; Health care; Typ 2 diabetes; Unmet need