Some insights here on the impact of forgone health care, including among patients with cardiovascular disease, at a time when many people around the world must make the difficult decision to forgo necessary medical care due to cost, which is especially difficult for those who live in low- to middle-income nations where the proportion of out-of-pocket spending can be significant
Medical Doctor, Ras Desta Damtew Memorial Hospital
Addis Ababa, Ethiopia
Forgone Health Care Among Patients With Cardiovascular Disease
Forgone treatment is defined as the frequency of a person’s self-report of skipping out on medical care while they were ill and in need of it in the year before to the survey day (1). People who report forgoing medical care do not use medical services even when they believe they are necessary (2). Forgoing care is a significant factor in evaluating the effectiveness of the healthcare system because it highlights a discrepancy between the public’s perception of their need for care and their actual utilization. Lack of care can have a variety of negative effects, such as the advancement of an illness, increased usage of emergency rooms, “worrying,” and/or difficulties going about daily tasks (2,3). People who report forgoing care can be categorized into two groups: group (I) people who believe they need healthcare and a professional would confirm that need (both subjective and objective need) and group (II) people who believe they need healthcare but a professional would not confirm that need (subjective but not objective need). Both types of forgone care are of high relevance for the respective individuals, health care providers, and, eventually, the health care system. Reported forgone care points to impediments to healthcare utilization (2). According to a recent World Health Organization (WHO) report, the cost of healthcare has thrown roughly 100 million people worldwide into “severe poverty.” Many people around the world must make the difficult decision to forgo necessary medical care due to cost, which is especially difficult for those who live in low- to middle-income nations where the proportion of out-of-pocket spending can be significant (4).
Despite the expansion of affordable medication options and treatment options, high rates of morbidity, disability, and early death are linked to cardiovascular diseases. Despite the availability of treatment alternatives, the majority of cardiovascular disease patients had uncontrolled blood pressure and glucose level. Patients with chronic diseases showed considerably higher likelihoods of forgoing both outpatient and inpatient care due to their higher demand for healthcare services (5,6). Studies have identified forgone care and care delays as common causes of these hospitalizations for preventable cardiovascular illness, which are commonly characterized as those that might have been avoided with greater access to high-quality care (7).
Research on forgone care among patients with cardiovascular disease has mainly been carried out in the Europe, USA and Canada. Research from Africa is largely unavailable. One in six cardiovascular disease patients and 15% of diabetic patients in the United States, 45% of type 2 diabetic patients in Iran, and 21.4% of patients in Switzerland forgoing health care for different reasons. In a study done in USA more than 76% of those who delayed or forgo getting medical attention had one or more chronic illnesses, such as cancer, heart disease, diabetes, hypertension, respiratory problems, and mental health issues (3). One in three (32.6%) adults who delayed or forgo getting medical care said it made one or more of their conditions worse or made it harder for them to work or do other daily tasks. Since many patients with chronic conditions need on going care, these persons and their families can incur high out-of-pocket medical expenses and run the risk of forgoing necessary treatments (11). A higher risk of forgone treatment exists among some groups of people who lack health insurance, have low incomes, and have comorbidities (1,7,9,10). Despite the fact that many studies have been conducted in developed countries, there have been few studies conducted in developing countries about forgone care. A significant public health issue is identifying which individuals are forgoing medical appointments, as this information enables targeted interventions or the distribution of important messages to address this dropout and its effects. Previous research has associated delayed and forgone medical care with lower health outcomes and more expensive medical care, particularly in the older population (8).
- Jalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health. 2021 Aug 24;21(1):1588.
- Röttger J, Blümel M, Köppen J, Busse R. Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals. Health Policy [Internet]. 2016 Feb [cited 2022 Dec 22];120(2):170–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0168851016000051
- Anderson KE, McGinty EE, Presskreischer R, Barry CL. Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic. JAMA Netw Open [Internet]. 2021 Jan 21 [cited 2023 Feb 6];4(1): e2034882. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775366
- Global Health Expenditure Database [Internet]. [cited 2023 Feb 6]. Available from: https://apps.who.int/nha/database/
- Oline BR, Pharm D. Hypertension: The Silent Killer. JNC-8. 2018;
- WHO, 2021 August 25. https://www.who.int/news-room/fact-sheets/detail/hypertension
- Thomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, et al. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Fail [Internet]. 2021 Oct [cited 2023 Jan 18];9(10):710–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213177921002365
- Li X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open [Internet]. 2018 Mar [cited 2023 Feb 6];8(3):e019901. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-019901
- Towne SD, Bolin J, Ferdinand A, Nicklett EJ, Smith ML, Ory MG. Assessing Diabetes and Factors Associated with Foregoing Medical Care among Persons with Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011-2015). Int J Environ Res Public Health. 2017 Apr 26;14(5):464.
- Menon LK, Richard V, de Mestral C, Baysson H, Wisniak A, Guessous I, et al. Forgoing healthcare during the COVID-19 pandemic in Geneva, Switzerland – A cross-sectional population-based study. Prev Med [Internet]. 2022 Mar [cited 2023 Feb 6];156:106987. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8828292/
- Kabia E, Goodman C, Balabanova D, Muraya K, Molyneux S, Barasa E. The hidden financial burden of healthcare: a systematic literature review of informal payments in Sub-Saharan Africa [Internet]. Harvard Dataverse; 2021 [cited 2023 Feb 22]. Available from: https://dataverse.harvard.edu/citation?persistentId=doi:10.7910/DVN/NMQCSF