Unmet Healthcare Need: Financial Barriers and the Dutch Deductible System

Abstract

This study examined how subjective financial worry (SFW), objective financial scarcity (OFS), and morbidity influence deductible choices and unmet healthcare needs under the Dutch health insurance deductible system. Guided by Andersen’s Behavioral Model (ABM) and the Behavioral Hazard (BH) framework, logistic regression analyses were conducted using cross-sectional data from the Dutch LISS panel (N = 1,806). Findings revealed morbidity significantly reduced voluntary deductible (VD) uptake (OR = 0.42, 95% CI [0.32, 0.55], p < .001), while strongly increasing the risk of unmet healthcare needs (OR = 4.09, 95% CI [2.94, 5.69], p < .001). Additionally, demographic factors including younger age (linear OR = 0.95; quadratic OR = 0.999, both p < .001), female sex (OR = 0.65, p = .001), and lower education (OR = 0.50, p = .004) significantly reduced VD uptake. Contrary to predictions from BH, neither SFW, OFS, nor their interaction significantly impacted deductible uptake or unmet healthcare needs. Results suggest morbidity and demographic factors are determinants of healthcare utilization decisions that overshadows psychological financial perceptions. Practically, this underscores that policy interventions aimed at reducing cost barriers may be more effective if targeted toward clinically vulnerable populations rather than addressing financial worry more broadly. Future research should explore longitudinal designs to more effectively assess subjective financial factors and their potential temporal dynamics