Health care renunciation for economic reasons in Switzerland

H Wolff,Jm Gaspoz,I Guessous

doi:10.4414/smw.2011.13165

Abstract

Most societies elaborate ways to contain increasing health care expenditures. In Switzerland out of pocket payments and cuts in the catalogue of reimbursed services are used as cost-containment measures. The aims of the study were to estimate the extent of health care renunciation for economic reasons and to identify associated factors. A population-based cross-sectional survey (2008-2009) of a representative sample in the Canton of Geneva, Switzerland. Health care underuse, income level categories (<CHF 3000/month, 3000-4999, 5000-6999, 7000-9499, 9500-13000, >13000), education, occupation, insurance status and cardiovascular comorbidities were collected using self-rated questionnaires. 765 men and 814 women aged 35-74 years participated. 14.5% (229/1579) (95% CI 12.7-16.2) renounced health care for economic reasons. Among those who renounced (N=229), 74% renounced dental care, 37% physician consultation (22% specialist, 15% general practitioner), 26% health devices, 13% medication, and 5% surgery. Income was negatively correlated with renouncement (r=-0.18, p<.0001). Each decrease in income level category provided a 48% increased risk of renouncing health care for economic reasons (OR 1.48, 1.31-1.65). This association remained when dental care was excluded from the definition of health care renunciation. In a region of Switzerland with a high cost of living, such as Geneva, socioeconomic status may influence the use of the health care system, and renunciation for economic reasons was not uncommon. More than 30% of the lowest income group renounced health care for economical reasons in the previous year. Health care underuse and renunciation may worsen the health status of a substantial part of society.

Highlights

IntroductionSwitzerland, which ranks second in the list of the world’s most expensive health care systems, has universal health-insurance coverage, permitting access to a broad range of services
Most societies elaborate ways to contain increasing health care expenditure
48% increased risk of renouncing health care for economic reasons. This association remained when dental care was excluded from the definition of health care renunciation

Summary

Introduction

Switzerland, which ranks second in the list of the world’s most expensive health care systems, has universal health-insurance coverage, permitting access to a broad range of services. Health insurance is compulsory for all citizens of Switzerland (7 million) and insurance premiums are paid independently of earnings [2]. Health insurance covers the costs of medical treatment and hospitalisation of the insured. The insured person pays part of the cost of treatment: 1. An annual flat deductible, called the franchise, which ranges from CHF 300 to a maximum of CHF 2,500 (1CHF ≈ 1$ ≈ 1.35€), at the insured person’s choice (premiums are adjusted ); and 2. A 10% deductible of the costs up to a stop-loss amount of CHF 700. Dental care is not included in the basic health insurance.

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