Renouncing care in French Guiana: the national health barometer survey
Open Access
- 6 February 2019
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Health Services Research
- Vol. 19 (1), 1-11
- https://doi.org/10.1186/s12913-019-3895-6
Abstract
In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.Keywords
Funding Information
- Santé Publique France
This publication has 20 references indexed in Scilit:
- Use of an Emergency Department in Saint-Laurent du Maroni, French Guiana: Does Being Undocumented Make a Difference?Journal of Immigrant and Minority Health, 2013
- Cervical Cancer Incidence in French GuianaInternational Journal of Gynecologic Cancer, 2012
- Migrant health in French Guiana: Are undocumented immigrants more vulnerable?BMC Public Health, 2012
- The role of patient navigators in eliminating health disparitiesCancer, 2011
- Why People Use Health ServicesThe Milbank Quarterly, 2005
- Social determinants of health inequalitiesThe Lancet, 2005
- Income-related inequalities in health: some international comparisonsJournal of Health Economics, 1997
- Socioeconomic determinants of health: Health inequalities: relative or absolute material standards?BMJ, 1997
- On going to see the doctor, the contributions of the patient to the decision to seek medical aid: A selective reviewJournal of Chronic Diseases, 1963
- Value and need as organizing factors in perception.The Journal of Abnormal and Social Psychology, 1947