Social differences in postponing a General Practitioner visit in Flanders, Belgium: which low-income patients are most at risk? E. Verlinde MA, PhD 1 , A. Poppe MA 1 , A. DeSmet MA 2 , K. Hermans MA, PhD 3 , J. De Maeseneer MD, PhD 1 , C. Van Audenhove MA, PhD 3 and S. Willems MA, PhD 1 1 Department of General Practice and Primary Healthcare, Ghent University, Ghent, Belgium, 2 Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium and 3 Lucas, Center for Care Research and Consultancy at K.U. Leuven, Leuven, Belgium Accepted for publication 12 November 2012 Correspondence E. Verlinde Department of General Practice and Primary Healthcare Ghent University, De Pintelaan 185 - 6K3 9000 Ghent, Belgium E-mail: Evelyn.Verlinde@ugent.be What is known about this topic • Studies show relatively high rates of postponing a visit to the GP by patients from lower socioeconomic groups due to factors related to the healthcare system. What this paper adds • Within a low-income population in Belgium, people with low trust in the GP, with ill health and people suffering from a severe depression have a higher chance of postpon- ing a visit to the GP than other low-income patients. The inability to make ends meet does not seem Abstract One of the main goals of primary care is providing equitable health-care, meaning equal access, equal treatment and equal outcomes of healthcare for all in equal need. Some studies show that patients from lower socio- economic groups visit a GP more often, while other studies show that they are more likely to postpone a visit to a GP. In this study, we want to explore within the social group of low-income patients living in Flanders, Belgium, which patients have a higher risk of postponing a visit to a GP. A face-to-face questionnaire was administered among 606 low-income users of Public Social Services. The questionnaire consisted of questions on socioeconomic and demographic characteristics, social networks, health and healthcare use. A multivariate logistic regression model was built to study the relationship between postponing or cancelling a GP visit which respondents thought they needed and variables on health, socio-demo- graphic background. The multivariate regression indicates that depression, self-rated health and trust in the GP independently predict postponing a visit to a GP. Low-income people with a low trust in the GP, people with a poor self-rated health and people suffering from a severe depression are more likely to postpone or cancel a GP visit they thought they needed compared to other people on low incomes. This might indicate that the access to health-care for low-income people might be hindered by barriers which are not directly linked to the cost of the consultation. Keywords: consultation, doctor–patient relationship, health disparities, low- income people, primary care, social class to lead to further postponing of health-care. • The universal approach for low- income people in Flanders seems to be able to reduce the financial barriers towards healthcare use, but the access to health-care for low-income people is still hindered by barriers that are not directly linked to the price of the consulta- tion. Introduction The socioeconomic conditions in which people live powerfully influence their chances to be healthy. Poverty, social exclusion, discrimination, poor housing, unhealthy early childhood conditions and low occupational sta- tus are important determinants of the systematic variations in health and illness between social groups, both between and within countries (White- head & Dahlgren 2006). Despite the marked improvements in the health of the general population, these health inequities seem to persist and even increase for some diseases and/or population groups (Hart 1971, White- head & Dahlgren 2006). Massive investment in further stimulation of the rise in (healthy) life expectancy will not automatically lead to less ineq- uity in health. However, actions that strengthen Primary Health Care (PHC) might. Evidence shows that a stronger primary care system–in © 2013 Blackwell Publishing Ltd 1 Health and Social Care in the Community (2013) doi: 10.1111/hsc.12027