Available evidence has suggested that strong primary care (PC) systems are associated with better outcomes. This study aims to investigate whether PC strength is specifically related to the prevalence of patients’ financially driven postponement of general practitioner (GP) care. Therefore, data from a cross-sectional multicountry study in 33 countries among GPs and their patients were analyzed using multilevel logistic regression modelling. According to the results, the variation between countries in the levels of patients’ postponement of seeking GP care for financial reasons was large. More than one third of these cross-country differences could be explained by characteristics of the health care system and the GP practices. In particular, PC systems with good accessibility and those systems that offer comprehensive care were associated with lower levels of financially driven delay. Consequently, we can conclude that well-organized PC systems can compensate for the negative influence of individual characteristics (socioeconomic position) on the care-seeking behaviors of patients.
BlumenthalD.MortE.EdwardsJ. (1995). The efficacy of primary care for vulnerable population groups. Health Services Research, 30, 253-273.
4.
BurströmB. (2002). Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s?Health Policy, 62, 117-129.
5.
DonabedianA. (1980). Explorations in quality assessment and monitoring (Vol. 1). The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
GoddardM.SmithP. (2001). Equity of access to health care services: Theory and evidence from the UK. Social Science & Medicine, 53, 1149-1162.
8.
HimmelsteinD. U.WoolhandlerS. (1995). Care denied: US residents who are unable to obtain needed medical services. American Journal of Public Health, 85, 341-344.
KringosD. S.BoermaW. G.BourgueilY.CartierT.HasvoldT.HutchinsonA.. . . TedeschiP. (2010). The European primary care monitor: Structure, process and outcome indicators. BMC Family Practice, 11(1), 81.
11.
KringosD. S.BoermaW. G.HutchinsonA.van der ZeeJ.GroenewegenP. P. (2010). The breadth of primary care: A systematic literature review of its core dimensions. BMC Health Services Research, 10(1), 1.
12.
KringosD. S. (2012). The strength of primary care in Europe. Utrecht, Netherlands: Utrecht University.
13.
KringosD.BoermaW.BourgueilY.CartierT.DedeuT.HasvoldT.. . . SvabI. (2013). The strength of primary care in Europe: An international comparative study. British Journal of General Practice, 63, e742-e750.
MacinkoJ.StarfieldB.ShiL. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Services Research, 38, 831-865.
16.
MackenbachJ. P.MeerdingW. J.KunstA. E. (2011). Economic costs of health inequalities in the European Union. Journal of Epidemiology & Community Health, 65, 412-419.
MerloJ.ChaixB.OhlssonH.BeckmanA.JohnellK.HjerpeP.. . . LarsenK. (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: Using measures of clustering in multilevel logistic regression to investigate contextual phenomena. Journal of Epidemiology & Community Health, 60, 290-297.
19.
NelsonD. E.ThompsonB. L.BlandS. D.RubinsonR. (1999). Trends in perceived cost as a barrier to medical care, 1991-1996. American Journal of Public Health, 89, 1410-1413.
20.
SchäferW. L.BoermaW. G.KringosD. S.De MaeseneerJ.GreßS.HeinemannS.. . . VainieriM. (2011). QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care. BMC Family Practice, 12(1), 115.
21.
SchäferW.L.BoermaW.G.KringosD.S.De RyckE.GreßS.HeinemannS.… GroenewegenP. (2013). Measures of quality, costs and equity in primary health care: instruments developed to analyse and compare primary health care in 35 countries. Quality in Primary Care, 21, 67-69.
22.
SnijdersT. A. B.BoskerR. J. (1999). Multilevel analysis: An introduction to basic and advanced multilevel modelling. Thousand Oaks, CA: Sage.
23.
StarfieldB. (1994). Is primary care essential?Lancet, 344, 1129-1133.
VilhjalmssonR. (2005). Failure to seek needed medical care: Results from a national health survey of Icelanders. Social Science & Medicine, 61, 1320-1330.
26.
WhiteheadM.HanrattyB. (2004). Health care for rich and poor alike. In HealyJ.McKeeM. (Eds.), Accessing health care: Responding to diversity (pp. 28-33). Oxford, England: Oxford University Press.
