Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Wendt - 2011 - Health Expectations
Abstract
Objective
This paper examines how negative experiences with the health-care
system create a lack of confidence in receiving medical care in seven
countries: Australia, Canada, Germany, the Netherlands, New Zealand, the
United Kingdom, and the United States.
Methods
The empirical analysis is based on data from the Commonwealth Fund
International Health Policy Survey 2007, with nationally representative
samples of adults aged 18 and over. For the analysis of the experience
of cost barriers and confidence in receiving medical care, we conducted
pairwise comparisons of group percentages as well as country-wise
multivariate logistic regression models.
Results
Individuals who have experienced cost barriers show a significantly
lower level of confidence in receiving safe and quality medical care
than those who have not. This effect is most pronounced in the United
States, where people who have foregone necessary treatment because of
costs are four times as likely to lack confidence as individuals without
the experience of cost barriers (adjusted odds ratio 4.00). In New
Zealand, Germany, and Canada, individuals with the experience of cost
barriers are twice as likely to report low confidence compared with
those without this experience (adjusted odds ratios of 1.95, 2.19 and
2.24, respectively). In the Netherlands and UK, cost barriers are only a
marginal phenomenon.
Conclusions
The fact that the experience of financial barriers considerably lowers
confidence indicates that financial incentives, such as private
co-payments, have a negative effect on overall public support and
therefore on the legitimacy of health-care systems.
