Avoidance of health care and changes in insurance premiums: a population-based study over 15 years in Geneva, Switzerland

Nehme M, Dumont R, Heritier H, Lamour J, Mechoullam S, De Ridder D and Guessous I (2025)

Forgoing Healthcare and Insurance Premiums Trends: A 15-Year Population-Based Study in Geneva, Switzerland, Int. J. Public Health 70:1609027. doi: 10.3389/ijph.2025.1609027

Summary :
Aims : Despite compulsory universal coverage, rising health insurance premiums in Geneva, Switzerland, can be a financial barrier to accessing healthcare. This study assesses trends in people foregoing care for financial reasons between 2011 and 2025, and their associations with insurance premiums, socio-economic factors and health-related factors.

Methods : We conducted an annual cross-sectional study of 1,000 participants in the Bus Santé study, randomly selected each year between 2011 and 2025 (n = 10,169). The primary endpoint was participants' self-reported failure to seek care for financial reasons. Temporal trends and associations with premiums were analysed using Locally Estimated Scatterplot Smoothing (LOESS) regressions. Logistic regressions were used to assess associations with individual determinants.

Results: A total of 18.1% of participants declared that they had foregone care, a proportion that would rise from 15.8% in 2011 to 25.8% in 2025 (+64.6%), in parallel with a 61.9% increase in premiums. Although low income remains a major predictor (aOR 2.33 [1.76-3.09]), increases in the foregoing of care have also been observed among higher income groups. Strong correlations were found between increases in premiums and avoidance of care, particularly among women (0.813) and young adults (0.805).

Conclusion : Further reforms are needed to reduce the growing inequalities in access to healthcare, despite the existence of compulsory universal cover.

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This text was automatically translated from French using artificial intelligence