Impact of financial barriers on health status, healthcare utilisation and economic burden among individuals with cognitive impairment: a national cross-sectional survey

Abstract

ObjectiveTo study the impact of financial barriers to healthcare on health status, healthcare utilisation and costs among patients with cognitive impairment.DesignCross-sectional.SettingNational Health Interview Survey (NHIS), 2011–2017.ParticipantsPatients with cognitive impairment aged 18 years or older.InterventionsFinancial barriers to healthcare were identified using a series of NHIS prompts asking about the affordability of healthcare services.Primary outcome measuresHealth status was based on a survey prompt about respondents’ general health. Healthcare utilisation included office visits, home healthcare visits, hospital stays and emergency department (ED) visits. Economic burden was based on the family spending on medical care. Logistic regression models were used to examine the impact of financial barriers to healthcare access on health status, home healthcare visits, office visits, hospital stays and ED visits, respectively.ResultsCompared with cognitively impaired respondents without financial barriers to healthcare access, those with financial barriers were more likely to be unhealthy (OR 0.64, 95% CI 0.57 to 0.72). Cognitively impaired respondents with financial barriers were less likely to have home healthcare (OR 0.69, 95% CI 0.48 to 0.99) and more likely to have hospital stays (OR 1.33, 95% CI 1.19 to 1.48) and ED visits (OR 1.50, 95% CI 1.35 to 1.67). In addition, compared with cognitively impaired respondents without financial barriers to healthcare access, those with the barriers were more likely to have an increased economic burden (OR=1.85, 95% CI 1.65 to 2.07).ConclusionFinancial barriers to healthcare worsened health status and increased use of ED, hospitalisation and economic burden. Policy decision-makers, providers and individuals with cognitive impairment should be aware of the impact of financial barriers and take corresponding actions to reduce the impact.

Factors influencing the help-seeking behavior in patients with mild cognitive impairment: a qualitative study

“…They only visit the hospital when their sickness worsens due to the high cost of examination and treatment. Patients with poor economic status were more likely to delay seeking medical help, which was consistent with previous research [ 52 ]. In addition, low-income patients often must work longer hours or at a higher intensity, which can make them less attentive to their health conditions and needs.…”

Healthcare use according to deprivation among French Alzheimer's Disease and Related Diseases subjects: a national cross-sectional descriptive study based on the FRA-DEM cohort

“…Moreover, the most deprived subjects may have low health education and literacy, with little attention given to their health in comparison with their other needs (such as living conditions). This low health education could lead to poorer compliance with recommended ambulatory and preventive healthcare for the most deprived subjects, leading to greater use of emergency room visits with or without hospitalization ( 21 , 22 , 44 ) and potentially avoidable hospitalization. This poor compliance could also partly explain the greater proportion of most deprived subjects without drug reimbursement during the year.…”

“…In ADRD, deprivation has been suggested to be associated with a delayed diagnosis ( 16 – 18 ) and a stronger mortality ( 19 , 20 ). It could complicate access to such recommended healthcare or be associated with non-recommended healthcare use ( 18 , 21 , 22 ), such as emergency care or inappropriate psychotropic drug use. However, there is scarce literature about global healthcare use (not focusing on only a part of healthcare) among subjects with ADRD according to deprivation, especially recommended healthcare (such as physiotherapy or nursing care).…”

“…The latter can be minimized through complementary health insurance and full exoneration of healthcare for some costly chronic diseases, such as ADRD. However, there is still a variable out-of-pocket expense ( 21 , 22 ). Despite its high level of investment in healthcare provision and social protection, France is characterized by wider social inequalities in mortality ( 24 ) and persistent significant social health inequalities ( 25 ), leading to the implementation of policies to reduce social health inequities ( 23 , 26 , 27 ).…”

Rehabilitation access for individuals with cognitive‐communication challenges after traumatic brain injury: A co‐design study with persons with lived experience

“…There may be additional barriers to rehabilitation access for individuals with TBI‐related cognitive‐communication deficits, as they may have particular difficulties with the type of healthcare communications required for service access (MacDonald, 2017). There is evidence that, as a group, adults with cognitive impairments use fewer healthcare services than those without cognitive impairments (e.g., Lu et al., 2022; Mejia‐Arango et al., 2021), but research has focused mostly on how lack of access to healthcare funding can increase risks for cognitive impairment (e.g., via increasing risk of disease; (Mullins et al., 2021), rather than on how cognitive impairments can influence access to healthcare funding. The latter is particularly relevant for individuals with TBI, who are at high risk for cognitive‐communication deficits (Togher et al., 2023).…”