Socioeconomic Determinants of Unmet Need for Outpatient Healthcare Services in Iran: A National Cross-sectional Study

Abstract

Background: Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods: We used the data of 13005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariate logistic regression was used to determine significant predictors of unmet need and associated major reasons. Results: About 17% of the respondents (N=2,217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Low education was associated with higher responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles and people with higher outpatient needs, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The elderly and those with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Conclusion: It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.