Financial accessibility of healthcare: characteristics of people who refrain from healthcare due to costs over the period 2016–2024, a repeated cross-sectional study

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 vulnerable people, like low-income groups, being more likely to refrain from care due to costs. 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 the period 2016-2024 (response 41%-56%). The samples were representative of the Dutch adult population regarding age and gender. Multivariate logistic regression analyses were performed to identify characteristics associated with refraining from care due to costs. Refraining from care due to costs was operationalised as refraining from (1) seeing a doctor, (2) a medical examination, treatment or post-treatment and/or (3) medication. RESULTS: Percentages of refraining from care due to costs ranged from 7% to 16%. A higher income, better financial situation, better self-reported health, being older, and having no migration background were related to lower odds of refraining from care due to costs. When income and financial situation are taken together in the analysis, only financial situation plays a role in refraining from care due to costs. In addition, we found that from 2021 onwards, income is no longer associated with refraining from care due to costs. The association of financial situation with refraining from care due to costs increases over the years 2019-2024. CONCLUSIONS: Financial situation seems to play a more important role in refraining from care due to costs than net monthly 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.