# Trends in cost-related forgone care among older adults in Switzerland: a repeated cross-sectional study

## TL;DR

This study finds that one in five older Swiss adults skip medical care due to cost, with growing income-related disparities despite universal health insurance.

## Contribution

The study reveals widening income disparities in cost-related forgone care among Swiss older adults from 2017 to 2024.

## Key findings

- 20% of older Swiss adults forgo medical care due to cost in 2024, with dental care being most affected.
- Income-related disparities in forgone care have widened since 2017, despite compulsory health insurance.
- Forgone care was more common among men and those aged 65–79 years.

## Abstract

Background: Ensuring equitable healthcare provision is key in ageing societies, yet it may be hindered by financial barriers. We assessed trends and socioeconomic disparities in cost-related forgone medical care among Swiss adults aged 65 years and older between 2017 and 2024. Methods: We used data from the 2017, 2021, and 2024 waves of the ‘International Health Policy Survey’, a population-based study of randomly sampled adults aged 65 or older (n = 2570, 1888, and 1948, respectively). Participants reported whether they had forgone medical prescriptions, consultations, medical tests, treatments or follow-up consultations, and dental visits due to cost. Weighted prevalence estimates were computed for services covered by the basic insurance and for dental care. Disparities by education and income were assessed using stratified analyses and the index of disparity. Results: Participants’ characteristics were stable across all waves (mean age 75; 54% women). In 2024, 20% reported forgoing at least one service due to cost (13% forgoing dental care, 13% insurance-covered services). Forgone care was similar in 2017 (21%) and lower in 2021 (16%). Forgone care was more frequent among men and participants aged 65–79 years. The index of disparity showed widening income-related disparities over time, while disparities by education remained stable. Dental care consistently showed the largest disparities. Conclusion: Despite Switzerland’s compulsory health insurance, one in five older adults still forgo care for financial reasons. Rates of forgone care remained stable, but income disparities have widened since 2017.