Factors associated with multiple barriers to access to primary care: an international analysis

Abstract

BackgroundDisparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems.MethodsIn this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions.ResultsOverall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care.ConclusionA greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vulnerable groups. The cumulative nature of these barriers remains to be assessed.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0740-1) contains supplementary material, which is available to authorized users.

Who experiences unmet need for mental health services and what other barriers to accessing health care do they face? Findings from Australia and Canada

“…Affordability‐related barriers were based on responses of “yes” to the questions: “during the past 12 months, was there a time when you i) had a medical problem but did not consult a doctor, ii) ‘skipped a test, treatment or follow up,’ or iii) ‘skipped medication or doses,’ ‘because of cost’?” As medication is an important part of care for mental conditions, a related barrier to access was considered if respondents answered “no” when asked if “in the past 12 months, has a doctor, nurse, or pharmacist reviewed with you all the medications you take.” Finally, we sought to consider a measure reflecting a potential lack of trust in the system. From previous analysis of potential barriers to accessing care, negative views of the health system were found to be more common people with mental health condition than people without a condition . Respondents were asked “which of the following statements comes closest to expressing your overall view of the healthcare system in your country?” We considered responses suggesting the system “has so much wrong with it that we need to completely rebuild it’ as a proxy for respondents’ potential lack of trust in the system, and a possible perceived barrier as to the approachability of care.…”

“…From previous analysis of potential barriers to accessing care, negative views of the health system were found to be more common people with mental health condition than people without a condition. 27,28 Respondents were asked "which of the following statements comes closest to expressing your overall view of the healthcare system in your country?" We considered responses suggesting the system "has so much wrong with it that we need to completely rebuild it' as a proxy for respondents' potential lack of trust in the system, and a possible perceived barrier as to the approachability of care.…”

The response of health systems to after‐hours primary cares in Iran and the selected countries

“…In Australia and Turkey, the main primary care is provided by GPs at their offices. In Australia, since 2013, following incentives given to GPs, approximately 66% of them (N = 4600) created the required arrangements at their offices and provided out‐of‐hours medical care for their patients . In Turkey, family physicians individually or in a group provided out‐of‐hours medical care for their patients.…”

International comparisons of disparities in access to care for people with mental health conditions

“…People with MHCs were less likely to receive medically necessary procedures for circulatory disease in Canada . In Australia, people with MHCs have higher out‐of‐pocket health‐care costs and to be more likely to forego care due to cost than people with no chronic conditions . Adults with MHCs were more likely than to experience multiple barriers to accessing primary care than those without a condition—a finding observed for Australia, Canada, New Zealand, Switzerland, Sweden, and the United States .…”