ABSTRACT
Forgoing healthcare for economic reasons has been previously associated with adverse health outcomes, including a higher risk of hospitalization, a lower quality of life, and worse self-reported health. However, the exact cause-to-effect relation between forgoing healthcare and health-related outcomes has been insufficiently described. Here, we investigate the prospective health consequences of forgoing healthcare for economic reasons using data from "ReBus" (N = 400), a prospective study examining the health consequences of forgoing healthcare (Baseline: 2008-2013, Follow-up: 2014-2016). Using regression models, we explored the baseline determinants of forgoing healthcare, including socioeconomic, demographic, and pre-existing health-risk factors, and examined the associations between forgoing healthcare at baseline and health deterioration at follow-up, using highly pertinent biomarkers (glucose, glycated hemoglobin, lipids, blood pressure) and SF-36 questionnaire data. Low income, low occupation, low education, and smoking were associated with higher odds of forgoing healthcare at baseline. Forgoing healthcare for economic reasons at baseline was subsequently related to detrimental changes in glucose, high-density lipoprotein cholesterol (HDL), and blood pressure (BP) at follow-up, independently of baseline socioeconomic factors (Glucose-ß = 0.19, 95%CI[0.03;0.34], HDL-ß = -0.07, 95%CI[-0.14;0.01], BP-ß = 3.30, 95%CI[-0.01;6.60]). Moreover, we found strong associations between forgoing healthcare and adverse SF-36 health scores at follow-up, with individuals forgoing healthcare systematically displaying worse health scores (6%-11% lower scores). For the first time, we show that forgoing healthcare for economic reasons predicts adverse health-related consequences 2-8 years later. Our findings shall further encourage the implementation of public health measures aimed at identifying individuals who forgo healthcare and preventing the adverse health consequences of unmet medical needs.
ABSTRACT
At the beginning of the twenty-first century, migratory movements have never been so large and complex. After describing the risk factors influencing the health of migrants in vulnerable situations (asylum seekers, undocumented migrants), this article attempts to describe a holistic model of access to care for this type of population. It also develops a plea for equitable treatment of migrants in their host country, while respecting basic human rights and the independence of the medical profession.
En ce début de XXIe siècle, les mouvements migratoires n'ont jamais été aussi nombreux et complexes. Après avoir décrits les facteurs de risque influençant la santé des migrants en situation de vulnérabilité (demandeurs d'asile, sans-papiers), cet article s'attache à décrire un modèle holistique d'accès aux soins pour ce type de population. Il développe également un plaidoyer pour une prise en charge équitable des migrants dans leur pays d'accueil, dans le respect des droits humains fondamentaux et de l'indépendance de la profession médicale.
Subject(s)
Health Services Accessibility , Refugees , Transients and Migrants , Vulnerable Populations , Human Rights , HumansABSTRACT
Traditionally, the doctor has focused his efforts on mastering medical knowledge. Given the challenges facing him, the medical institutions and the society, it becomes clear that his concern must also be about how this medical knowledge hits the patients and the general population. Knowing how to deliver our care is now as important as having the medical knowledge ! In this article, we present new models of healthcare delivery that we implemented or plan to implement in Geneva, Switzerland.
Traditionnellement, le médecin a concentré ses efforts sur la maîtrise de la connaissance médicale. Face aux enjeux qui se présentent à lui, aux institutions et à la société, il devient évident que sa préoccupation doit également se porter sur la façon dont cette connaissance médicale atteint les patients et la population en général. Savoir délivrer nos soins est désormais aussi important que d'avoir les connaissances médicales ! Dans cet article, nous présentons des nouveaux modèles de soins de santé que nous avons mis en Åuvre ou prévoyons de mettre en Åuvre à Genève, en Suisse.
