The link between financial problems, health status and medical care

Abstract

Background: About ten percent of European households are unable to cover payment obligations and living expenses with available income and assets on an ongoing basis, and are thus considered over-indebted. Mounting international evidence suggests that over-indebtedness might reflect a potential cause and consequence of health problems and contribute to limited access to health care. However, little is known about the relationship between over-indebtedness and mental illness, medication use and patient-physician communication among the over-indebted, specifically in Germany. <br /> Methods: An explorative cross-sectional survey among clients of 70 debt advice agencies was conducted in North Rhine-Westphalia, Germany, in 2017 (German acronym: ArSemü). Data on health status, medication use and health care utilization were collected by using a self-administered written questionnaire which was returned by 699 individuals with a response of 50.2 %. Descriptive statistics and multiple logistic regression analysis were used to examine antidepressant use, cost-related medication nonadherence (CRN) and patient-physician communication about financial problems. To examine the association between over-indebtedness and mental illness, data were merged with the first wave of the German Health Interview and Examination Survey for Adults (DEGS1, n=7115) which provides representative data for the adult population living in Germany. <br /> Results: The over-indebted were significantly more likely to use antidepressants than the German general population after controlling for other socioeconomic, demographic and health factors (aOR 1.83; 95 % CI 1.35-2.48). The prevalence of CRN was 33.6 % (n=203). Those who reported a chronic illness or communication about financial problems in general practice had significantly greater odds of CRN. Patient-physician communication about financial problems with general practitioners was reported by 22.6 % (n=135) of respondents. There was a significant association between patients' educational level, ethnic origin, health status, level of financial distress and strategies to cope with medication cost, and patient-physician communication. <br /> Conclusions: Stakeholders in health care, debt counselling, research and policy should consider over-indebtedness as a specific risk factor for health problems and limited access to medical care. Preventive measures are needed to address the complex link between over-indebtedness and illness.