Financial accessibility of healthcare: characteristics of people who refrain from healthcare

Abstract Background affordability is an important dimension of access to healthcare. Out-of-pocket payments could lead to refraining from care. Current increased costs of living and care may lead to certain groups of people being more likely to refrain from care due to costs. It is expected that these rising costs mainly impact low-income groups and younger citizens. This study aims to assess the characteristics of people who refrain from healthcare due to costs over the period 2016-2024. Methods questionnaires were sent out to samples of 1,500 panel members of the Nivel Dutch Health Care Consumer Panel in 2016-2024 (response 41%-56%). The samples were representative of the Dutch adult population. Multivariate logistic regression analyses were performed to identify characteristics associated with refraining from care due to costs. This was operationalised as refraining from 1) seeing a doctor, 2) a medical examination, and/or 3) treatment or post-treatment and medication. Results percentages of refraining from care due to costs ranged from 7% to 16%. Amongst others, a higher income (p < 0.01), a better financial situation (p < 0.01), a better perceived health (p < 0.01), being older (p < 0.05), and having no migration background (p < 0.05) were in all years related to lower odds of refraining from care due to costs. Financial situation seems to play a more important role than income. The association between income and refraining from care decreased over the years. Conclusions preliminary results show vulnerable groups are more likely to refrain from care due to costs. Financial situation seems to play a more important role than income. It is important that, when countering refraining from care due to costs, attention is paid to the whole group of people with a poorer financial situation and not only to those with low incomes. Key messages • Vulnerable groups are more likely to refrain from care due to costs. • Financial situation seems to play a more important role in refraining from care due to costs than income.