Financial barriers to healthcare access among socioeconomically disadvantaged populations: Caring and Responding in Edmonton Project

Purpose Despite progress towards Universal Health Coverage (UHC) in high-income countries, people experiencing socioeconomic disadvantages often struggle to access healthcare services not covered by public health insurance. This study explores the factors contributing to financial barriers to healthcare access (FBHA) among socioeconomically disadvantaged individuals in Edmonton, Canada. Design/methodology/approach Employing a convergent parallel mixed-method cross-sectional design, the study collected both quantitative and qualitative data through an interviewer-administered questionnaire. Logistic regression was used to examine associations between socioeconomic indicators and FBHA, while qualitative data were analyzed using inductive qualitative content analysis. Findings Among the 392 participants, 62.50% were women, 39.03% experienced housing instability, 49.49% reported health conditions, and 38.78% encountered FBHA for services not covered by public health insurance. Having additional health insurance (OR = 0.40, 95% CI: 0.24–0.65) and housing stability (OR = 0.46, 95% CI: 0.27–0.78) were associated with lower odds of FBHA; however, experiencing food insecurity was associated with greater odds (OR = 3.85, 95% CI: 1.66–8.93). Participants reported numerous health needs remaining unaddressed due to prohibitive costs, including dental and vision care, mental health services, prescription medications, and other essential services. Originality/value This study offers original contributions by focussing on individuals excluded from healthcare due to financial barriers, an often-overlooked group in healthcare access research, and by clarifying where such barriers may persist despite UHC. To substantiate this focus, the study integrates quantitative estimates with community-informed evidence and specifies how food insecurity, housing instability, and limited additional insurance converge to sustain unmet needs. The findings suggest that more inclusive policies and targeted interventions might be warranted.