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The European Journal of Public Health Advance Access published online on June 23, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki096
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved
Received August 31, 2004
Accepted February 24, 2005

Article

Original approach to the individual characteristics associated with forgone healthcare

Fabienne Bazin 1, Isabelle Parizot 1, and Pierre Chauvin 1*

1 INSERM, Research Team on Social Determinants of Health and Healthcare, Paris, France

* To whom correspondence should be addressed.
Pierre Chauvin, E-mail: chauvin{at}u707.jussieu.fr


  Abstract

Background: The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s. Our objective was to identify the individual characteristics (socio-economic status, living conditions, individuals' social integration, health beliefs, expectations and representation and psychological characteristics) statistically associated with the fact of stating (or not) that healthcare had been forgone because of cost. Methods: In this cross-sectional, multi-centre study we randomly selected a study sample from five underprivileged areas in the Paris region. A multiple logistic regression model was used to calculate the odds ratios (OR) and 95% confidence interval (CI). The validity of the model was assessed by goodness-of-fit tests (Pearson and deviance) and by the study of 100 bootstrap samples. Results: After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood [ORyes/no=5.47 (1.44-20.75)], a life-course experience of physical, sexual or psychological abuse [ORyes/no=2.86 (1.40-5.84)]; who have experienced childhood difficulties [OR1/never difficulties=5.28 (1.81-15.39), OR2-4/never=7.62 (2.69-21.57), OR>4/never=8.57 (2.39-30.80)]; who have expressed a low degree of sickness orientation [ORlow/high=2.62 (1.33-5.14)], a high worry/concern about health [ORhigh/low=2.71 (1.33-5.50)] and a low self-esteem [ORmedium/high=8.28 (1.44-47.64), ORlow/high=16.44 (2.81-96.24)]. Conclusion: Aside from purely financial hurdles, other factors play a role in the non-use of healthcare services. Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities.

Keywords: health behaviour; healthcare access; life change events; logistic models; psychosocial factors.
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