Family income and insufficient medical care: A prospective study of alternative explanations

Aims: Equity of access to medical care is a central objective in socialised and national health insurance systems. Based on a national panel survey of Icelandic adults, the study examined the effects of family income on insufficient medical care and whether income-related differences were explained by overall financial strain, health-care cost burden, cultural variables or barriers related to health-system obstacles or experiences. Methods: The study used two-wave panel data from national postal health surveys of Icelandic adults aged 18–75. Insufficient medical care was assessed in terms of both reported delay/cancellation of physician care and estimated underutilisation when comparing actual and professionally recommended physician visits. Results: The study found that individuals with lower family incomes were more likely to delay or cancel a needed physician visit and underutilise medical care compared to their higher-income counterparts. High relative out-of-pocket costs, overall financial strain and negative experiences of medical care fully accounted for the disadvantaged medical access of lower-income individuals. The most important explanatory variable was out-of-pocket costs, as it affected insufficient medical care both directly and indirectly by compounding economic difficulties in the family. Attitudes, beliefs and health-related behaviours had limited effects on insufficient medical care and did not account for income-related differences. Conclusions: Poorer access to needed medical care among lower-income individuals was explained by high relative out-of-pocket costs, overall financial strain and negative medical-care experiences. Efforts to reduce income differences in access to needed medical care should address these factors.