Here comes the SUN: Self‐assessed unmet need, worsening health outcomes, and health care inequity

Abstract

Utilization-based approaches have predominated the measurement of socioeconomic-related inequity in health care. This approach, however, can be misleading when preferences over health and health care are correlated with socioeconomic status, especially when the underlying focus is on equity of access. We examine the potential usefulness of an alternative approach to assessing inequity of access using a direct measure of possible barriers to access-self-reported unmet need (SUN)-which is documented to vary with socioeconomic status and is commonly asked in health surveys. Specifically, as part of an assessment of its external validity, we use Canadian longitudinal health data to test whether self-reported unmet need in one period is associated with a subsequent deterioration in health status in a future period, and find that it is. This suggests that SUN does reflect in part reduced access to needed health care, and therefore may have a role in assessing health system equity as a complement to utilization-based approaches.

Evolution of the determinants of unmet health care needs in a universal health care system: Canada, 2001–2014

“…Personal reasons capture when a need goes unmet due to individual choice, preferences or constraints not directly amenable to by the health care system. System reasons hence have direct relevance for health policy, while personal reasons have implications for inequity measurement (Allin et al ., 2010; Gibson et al ., 2019). Previous studies have offered similar categorizations, though differing in labeling and placement on waiting times (Allin et al ., 2010) and knowledge of resources (Chen and Hou, 2002; Sibley and Glazier, 2009).…”

“…(2002) found that the prevalence of SUN in Canada increased from 4 to 12% over the period of 1994–2001, with health care system reasons (primarily long wait times) taking a larger proportional share. From an academic perspective, knowing if the determinants of system reasons for SUN are consistently different over time from those contributing to personal reasons allows an assessment of whether different types of individuals are more likely to have SUN of one type, which has implications for the measurement of inequity in health care (Gibson et al ., 2019).…”

Descriptive Data Analysis of Inequality of Economic Opportunity using the Queensland Family Cohort Pilot Study

“…Health service use variables, to some extent, describe the demand for services. From a health economics perspective, there is still, of course, unmet need, since use of services does not reflect all demand (Gibson et al, 2019). In addition, supplier induced demand may be an issue, if service providers are financially incentivised to provide extra care, which may be marginal to the health outcomes of the patient (Richardson, 1981).…”

Risk of Social Exclusion and Resources of Young NEETs

“…The refusal indicator is a subjective indicator, the qualities of which have been fully demonstrated. It makes it possible to identify unmet healthcare needs and is associated with lower healthcare use and a deterioration of the state of health (Allin et al, 2010;Dourgnon et al, 2012;Gibson et al, 2019). An initial general indicator of refusal is obtained from an affirmative response to at least one of the following three questions: "Within the last 12 months, have you refused to visit a doctor for medical examinations or healthcare/a dentist, for dental care/refused glasses, lenses, frames or contact lenses that you needed?".…”