title: Postponing a General Practitioner Visit: Describing Social Differences in Thirty-One European Countries.
abstract: To describe social differences in postponing a general practitioner visit in 31 European countries and to explore whether primary care strength is associated with postponement rates.
  
  
  
  Between October 2011 and December 2013, the multicountry QUALICOPC study collected data on 61,931 patients and 7,183 general practitioners throughout Europe.
  
  
  
  Access to primary care was measured by asking the patients whether they postponed a general practitioner visit in the past year. Social differences were described according to patients' self-rated household income, education, ethnicity, and gender.
  
  
  
  Data were analyzed using multivariable and multilevel binomial logistic regression analyses.
  
  
  
  According to the variance-decomposition in the multilevel analysis, most of the variance can be explained by patient characteristics. Postponement of general practitioner care is higher for patients with a low self-rated household income, a low education level, and a migration background. In addition, although the point estimates are consistent with a substantial effect, no statistically significant association between primary care strength and postponement in the 31 countries is determined.
  
  
  
  Despite the universal and egalitarian goals of health care systems, access to general practitioner care in Europe is still determined by patients' socioeconomic status (self-rated household income and education) and migration background.
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Jens
authors.initials: J
authors.lastname: Detollenaere
authors.affiliation: Department of Sociology, Ghent University, Ghent, Belgium.
authors.forename: Amelie
authors.initials: A
authors.lastname: Van Pottelberge
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Lise
authors.initials: L
authors.lastname: Hanssens
authors.affiliation: Department of Criminology, Criminal Law and Social Law, Ghent University, Ghent, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Pauwels
authors.affiliation: Netherlands Center for Social Care Research, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: van Loenen
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Sara
authors.initials: S
authors.lastname: Willems
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005060:Europe; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013222:State Medicine / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Europe; access; equity; postponement; primary health care