Physicians' Perceptions of Income-related Disparities in Medical Care Utilization: a Mail Survey in Tokyo

Abstract

Introduction: The rising poverty rate has spurred concerns regarding income-related disparities in medical-care utilization. This study attempted to investigate physicians'recognition of patients'refraining from medical care for financial reasons and the characteristics of physicians who made efforts to improve such situations.
Methods: A mail survey was conducted between July 1 and September 30, 2014. All internal medicine clinics (n=1989) in 12 municipalities in Tokyo were included. One physician from each clinic was requested to answer the 60-item questionnaire.
Results: Of the 617 questionnaires returned (response rate 31 %), 550 (454 male physicians) complete responses were analyzed. About 90% of physicians recognized that patients refrained from seeking medical care for financial reasons, and used various methods to encourage receipt of treatment (e.g., prescribing inexpensive medicines). Physicians who were 40-59 years old, specialized in general practice, implementing informed consent or shared decision making, and frequently recognizing that patients refrained from seeking medical care were more likely to engage in efforts to encourage treatment seeking.
Conclusion: Our results suggest that physicians in primary care roles such as general practice and utilizing shared decision making are more likely to engage in efforts to encourage medical care utilization in patients who refrain due to financial reasons.