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Unmet healthcare needs (or foregone healthcare) is a widely used intermediate indicator to evaluate healthcare systems attainment since it relates to health outcomes, financial risk protection, improved efficiency and responsiveness to the individuals' legitimate expectations. This paper discusses the ordinary measure of this indicator used so far, prevalence of unmet needs in the whole population, based on the level of healthcare needs among the population. The prevalence of needs and the prevalence of unmet needs among those in need are key aspects that have not yet been fully explored when it comes to foregone healthcare. We break down the ordinary measure into prevalence of needs and prevalence of unmet needs among those in need based on data taken from the European Social Survey 2014. Afterwards, we analyse these different measures in a cross-country perspective. We also discuss the link between them and the implicit relative assessment of healthcare systems considering the whole population and the sub-group of the population aged 65 or more. Comparisons across countries show different attainment levels unveiling varying challenges across European countries, depending on the combination of levels of need and levels of unmet needs for those in need., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This paper examines the determinants of unmet healthcare needs in Europe. Special emphasis is put on the impact of social capital. Data come from the European Social Survey, 2014. Our study includes 32,868 respondents in 20 countries. Because unmet needs are observed only in those individuals who are exposed to, and recognise, the need of medical care, sample selection can be an issue. To address it, we analyse the data using the bivariate sample selection model. When there is no need, there is no assessment of access to healthcare. Accordingly, in this situation, our model assumes that unmet need is unobserved. The magnitude and statistical significance of the error correlation support our modelling strategy. A high proportion (18.4%) of individuals in need in Europe reported unmet needs. Informal connections seem to mitigate barriers to access as well as trust in other people and institutions, particularly in health services. Financial strain still is a strong predictor of unmet needs. Other vulnerable groups include informal carers, minorities and individuals feeling discriminated. Unmet needs might also arise due to persistent needs of healthcare as it seems to be the case of individuals with lower health status and chronic conditions. A result that merits further research concerns the positive impact of civic engagement on unmet needs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: To evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey., Methods: The country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months. The dependent variable had three categories: no unmet need, unmet need due to cost, and unmet need due to availability (waiting list and distance problems). Predictors of unmet need were assessed by a multinomial logistic regression analysis., Findings: The prevalence of unmet need declined between 2006 and 2013. While educational inequalities in declared unmet need also decreased, the income gradient becomes more important. In 2013, controlling for other factors, the propensity to report unmet need was 10 times higher for those in the poorest-income quintile compared to the richest (versus 7 times in 2006)., Conclusion: Overall access to healthcare has gradually improved in Turkey in the health reform process, but 9% of people still declared unmet need due to cost in 2013, after the implementation of Universal Health Insurance. This was nearly four times the EU average. Unfavourable economic and labour market conditions can be challenges for effective universal health coverage., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The Korean government has established community health centers (CHC) since the end of the 20th century to improve community public health and access to healthcare. In this study, we investigated the reasons for unmet healthcare needs and the reasons/purposes for using CHC based on income level., Methods: We used data from the 2012 Community Health Survey, which was administered by the Korean Centers for Disease Control and Prevention (n=208,399). We performed the χ(2) test to examine differences between unmet healthcare needs and utilization of CHC based on various patient characteristics. Survey logistic regression models were used to examine unmet healthcare needs and utilization of CHC by income level. We also analyzed subgroup models to explain the reasons for the outcome variables., Results: A total of 22,901 (11.0%) individuals experienced unmet healthcare needs and 75,137 (36.1%) utilized CHC. Results of the survey logistic regression analysis revealed that the lowest-income population had a higher odds ratio (OR) for experiencing unmet healthcare needs (OR=1.61) and utilized CHC more frequently (OR=1.66). Their main reasons for unmet healthcare needs were economic (OR=5.75) and difficulties in transportation (OR=2.17). The lowest-income population visited CHC because of lower costs (OR=1.76) and close proximity to home (OR=1.56). The lowest-income population visited CHC for primary care (OR=1.22) and vaccinations (OR=1.23). In contrast, the highest-income group visited CHC primarily to obtain government-issued documents (OR=0.82)., Conclusions: Our results indicate different reasons/purposes for unmet healthcare needs and utilization of CHC based on income level. The government should use a management strategy to reduce unmet healthcare needs among the low-income population and redefine the roles of CHC., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aims: Even though basic healthcare services have been considered human rights, studies on optimal level of healthcare utilization have produced mixed results. A growing body of literatures has been using unmet healthcare needs, a subjective survey measure, to find inequity in healthcare. But no studies so far have tried to reveal the association of unmet needs with health outcomes so it was hard to get the public's attention. To answer it, this study tries to reveal the associations between unmet healthcare needs and health outcomes., Methods: A 4-year Korean panel dataset of 7,717 persons (31,668 person-years) were analyzed. Unmet healthcare needs were asked (if yes, its reason was also surveyed) if the respondent ever felt healthcare services were needed but could not receive it in the past 12 months. A health-related quality of life instrument (EQ-5D) and self-rated health were used as dependent variables. To avoid simultaneity, 1-year lagged outcome variables were used. And to control for unobserved individual heterogeneity, fixed effects estimation was also run based on Grossman's human capital model., Findings: Since 2009, more than 14.5% of the study population had reported unmet healthcare needs. When 1-year lagged health outcome variables were regressed on unmet needs, compared to the means, unmet needs were found to associate with 1% decline in EQ-5D and 4.5% decline in self-rated health. Unmet needs due to mild symptoms were not related with outcomes in fixed effects estimation among the elderly., Conclusions: Even though causal inference were not found, the association between unmet needs and health outcomes were established. Recognizing demand side determinants of healthcare was a strength of this study., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The purpose of study is to find relevance between unmet healthcare needs and employment status and if factors have relevance to unmet healthcare needs due to "economic burden" and "no time to spare"., Methods: The study conducted a survey of 9163 respondents who said they needed a medical treatment or checkup were asked why the need for care was unmet., Results: 22.9% of the respondents said they did not receive a medical treatment or checkup they needed at least once. The rate of unmet healthcare needs caused by "economic burden" was higher among temporary workers (ORs=2.13), day workers (ORs=1.92). However, the rate of unmet needs due to "no time to spare" was lower for temporary workers (ORs=.58) than for regular workers, studies (ORs=.33), housework (ORs=.26), early retirement (ORs=.19) and disease or injury (ORs=.07)., Conclusion: Non-regular waged workers were more likely to have an unmet need for healthcare due to "economic burden" than regular waged workers. On the other hand, regular waged workers were less likely to receive necessary healthcare services due to "no time to spare" than non-regular waged workers and economically inactive people., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)